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[Cardiac manifestations of phospholipid antibody syndrome. Study of 2 cases]
M Rojas1, R Gryman, V Bournazel
1Service de Néphrologie et de Réanimation polyvalente, Centre hospitalier, Montreuil.
Insights
Phospholipid antibody syndrome can cause severe cardiac issues, including valve disease and heart dysfunction. This study highlights two cases with extensive cardiac and systemic complications, showing treatment stability over time.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Phospholipid antibody syndrome (APS) is an autoimmune disorder associated with an increased risk of thrombosis and pregnancy morbidity.
- Cardiac manifestations of APS are diverse, potentially affecting heart valves, myocardium, and pulmonary circulation.
Observation:
- Two patients presented with a circulating anticoagulant, dissociated syphilis serology, and very high cardiolipin antibody levels.
- Both patients exhibited multiple cardiac complications consistent with APS, including valve disease, myocardial issues, and pulmonary hypertension.
- Systemic involvement was also noted, with renal disease in both patients and a history of venous thromboses and cerebrovascular accident in one.
Findings:
- The observed cardiac complications in these patients encompassed a wide spectrum of APS-related cardiovascular pathology.
- Simultaneous presence of circulating anticoagulant, specific serological findings, and high antibody titers confirmed the diagnosis of APS.
- Treatment with corticosteroids, and anticoagulants in one case, led to lesion stability over extended follow-up periods.
Implications:
- These cases underscore the significant cardiac burden of phospholipid antibody syndrome and the importance of early diagnosis.
- The findings suggest that aggressive management, including corticosteroids and anticoagulation, may stabilize cardiac lesions in APS.
- Further research into the long-term cardiac outcomes and optimal management strategies for APS is warranted.
Abstract:
Cardiac manifestations of phospholipid antibody syndrome may include mitral and/or aortic valve disease, pseudo-infectious endocarditis, thrombi of the right atrium, myocardial infection, pulmonary artery hypertension and cardiomyopathy with global or segmental left ventricular dysfunction. The authors report two patients showing evidence simultaneously of a circulating anticoagulant, dissociated syphilis serology and cardiolipin antibodies at a very high level. They had the majority of cardiac complications described in phospholipid antibody syndrome. Both also had renal involvement and one of them had recurrent venous thromboses and a cerebrovascular accident. Prolonged corticosteroid treatment, combined with anticoagulants in one patient, was accompanied by stability of lesions with follow-up of five years and ten months respectively.