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Heart Valve Involvement in Patients with Antiphospholipid Syndrome: A Long-Term Follow-Up Study of a Single Centre
Isaac Pons1,2,3, Joana Louro1,2, Marta Sitges2,4,5
1Department of Autoimmune Diseases, Reference Centre (UEC/CSUR) for Systemic Autoimmune Diseases of the Catalan and Spanish Health Systems, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain.
Insights
Heart valve disease is common in antiphospholipid syndrome (APS), affecting 50% of patients. This condition is linked to specific clinical features and a higher mortality rate, suggesting a distinct patient subgroup.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Antiphospholipid syndrome (APS) frequently involves cardiac structures, with valve disease being the most common manifestation.
- Understanding the characteristics and outcomes of APS patients with heart valve involvement is crucial for patient management.
Purpose of the Study:
- To determine the prevalence of heart valve involvement in antiphospholipid syndrome (APS) patients.
- To describe the clinical and laboratory features, and the evolution of APS patients with cardiac valve disease.
Main Methods:
- A retrospective, longitudinal, observational study was conducted.
- Data from APS patients with at least one transthoracic echocardiographic study were analyzed.
Main Results:
- Half of the 144 APS patients (50%) exhibited valvular involvement, most commonly mitral valve thickening (72%) and mitral regurgitation (68%).
- Patients with valve involvement were more likely to be female and have arterial hypertension, arterial thrombosis, stroke, livedo reticularis, and lupus anticoagulant.
- The valvular involvement group experienced significantly higher mortality (12% vs. 1%).
Conclusions:
- Heart valve disease is a frequent and significant manifestation in APS patients, associated with distinct demographic, clinical, and laboratory profiles.
- A subgroup of APS patients with moderate-to-severe valve involvement may possess unique characteristics warranting further investigation.
- These findings highlight the importance of cardiac monitoring in APS patients.
Background:
Valve involvement is the most common cardiac manifestation in antiphospholipid syndrome (APS). The objective of the study was to describe the prevalence, clinical and laboratory features, and evolution of APS patients with heart valve involvement.
Methods:
A retrospective longitudinal and observational study of all APS patients followed by a single centre with at least one transthoracic echocardiographic study.
Results:
144 APS patients, 72 (50%) of them with valvular involvement. Forty-eight (67%) had primary APS, and 22 (30%) were associated with systemic lupus erythematosus (SLE). Mitral valve thickening was the most frequent valve involvement present in 52 (72%) patients, followed by mitral regurgitation in 49 (68%), and tricuspid regurgitation in 29 (40%) patients. Female sex (83% vs. 64%; p = 0.013), arterial hypertension (47% vs. 29%; p = 0.025), arterial thrombosis at APS diagnosis (53% vs. 33%; p = 0.028), stroke (38% vs. 21%; p = 0.043), livedo reticularis (15% vs. 3%; p = 0.017), and lupus anticoagulant (83% vs. 65%; p = 0.021) were more prevalent in those with valvular involvement. Venous thrombosis was less frequent (32% vs. 50%; p = 0.042). The valve involvement group suffered from higher mortality (12% vs. 1%; p = 0.017). Most of these differences were maintained when we compared patients with moderate-to-severe valve involvement (n = 36) and those with no or mild involvement (n = 108).
Conclusions:
Heart valve disease is a frequent manifestation in our cohort of APS patients and is associated with demographic, clinical and laboratory features, and increased mortality. More studies are needed, but our results suggest that there may be a subgroup of APS patients with moderate-to-severe valve involvement with its own characteristics that differs from the rest of the patients with mild valve involvement or without valve involvement.
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