Heart valve involvement (Libman-Sacks endocarditis) in the antiphospholipid syndrome

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Antiphospholipid syndrome (APS) is characterized by anti-phospholipid antibodies (aPLs), thrombosis, pregnancy loss, or thrombocytopenia.
• APS can be primary or secondary to conditions like systemic lupus erythematosus (SLE).
• Echocardiography reveals heart valve abnormalities in approximately one-third of primary APS patients and a higher prevalence in SLE patients with aPLs.

Purpose of the Study:

• To investigate the prevalence and characteristics of valvular involvement in antiphospholipid syndrome (APS).
• To explore the association between anti-phospholipid antibodies (aPLs) and cardiac valve lesions.
• To understand the clinical implications and potential mechanisms of valvular disease in APS.

Main Methods:

• Echocardiographic studies were used to identify heart valve abnormalities.
• Clinical data from APS patients, including those with SLE, were analyzed.
• Pathological examination of affected valves was performed to identify immunoglobulin and complement deposits.

Main Results:

• Valvular lesions in APS manifest as nonbacterial vegetations or thickening, often affecting the mitral and aortic valves.
• These lesions can lead to valve dysfunction, primarily regurgitation.
• The presence of aPLs is associated with an increased risk of thromboembolic complications, particularly cerebrovascular events.

Conclusions:

• Anti-phospholipid antibodies (aPLs) play a role in the pathogenesis of valvular lesions in APS.
• aPLs may promote valve thrombus formation and other mechanisms involving immunoglobulin and complement deposition.
• Valvular involvement in APS, while often asymptomatic, increases the risk of thromboembolic events.