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Cerebrovascular ischemic events with high positive anticardiolipin antibodies
P Verro1, S R Levine, G E Tietjen
1Center for Stroke Research, Department of Neurology, Henry Ford Health Science Center (Detroit Campus of Case Western University), Detroit, Mich., USA.
Insights
High IgG anticardiolipin antibodies (aCL) are linked to frequent, minor cerebrovascular events in younger patients, often with associated risk factors. These high aCL titers did not worsen prognosis for disability or recurrent ischemic events compared to lower titers.
Area of Science:
- Neurology
- Immunology
- Vascular Medicine
Background:
- Antiphospholipid syndrome (APS) is a prothrombotic disorder characterized by antiphospholipid antibodies.
- High titers of anticardiolipin antibodies (aCL) are associated with increased thrombotic risk, but their specific prognostic value requires further elucidation.
Purpose of the Study:
- To characterize the patient profile associated with high positive IgG anticardiolipin antibodies (aCL).
- To evaluate the prognostic significance of high positive IgG aCL titers in patients with ischemic cerebrovascular disease.
Main Methods:
- Prospective study of 27 consecutive patients with IgG aCL titers >100 GPL.
- Assessment of clinical, laboratory, radiological features, and prospective follow-up for cerebrovascular and systemic ischemic events.
- Analysis of neurological impairment and correlation with aCL titers and other risk factors.
Main Results:
- The cohort, with a mean age of 41, predominantly had primary antiphospholipid syndrome (23 patients).
- Cerebral infarcts occurred in 74%, with 37% experiencing recurrent events. Systemic ischemic events occurred in 37%.
- High prevalence of tobacco use (85%), hyperlipidemia (74%), hypertension (44%), and lupus anticoagulant (72%) was observed. Neurological impairment was not correlated with aCL titer (P=0.567).
Conclusions:
- Cerebrovascular events associated with high positive IgG aCL are often multiple and minor, with no disability-titer correlation.
- These events occur in relatively young patients and are frequently linked to tobacco abuse, hyperlipidemia, lupus anticoagulant, systemic ischemic events, and occult cardiac disease.
- High IgG aCL titers did not confer a worse prognosis for disability and recurrent ischemic events compared to historical controls.
Background And Purpose:
The aim of our study was to characterize the patient profile and prognostic value associated with high positive IgG (>100 GPL) anticardiolipin antibodies (aCL).
Methods:
We studied the clinical, laboratory, radiological, and prospective historical features of ischemic cerebrovascular disease in patients with >100 GPL titers. From our neurology department, 27 consecutive patients were prospectively identified and followed up (mean follow-up time, 34 months).
Results:
The mean age of our cohort was 41 years. Lupuslike illness occurred in 3; 23 had primary antiphospholipid syndrome, including 3 who met criteria for Sneddon's syndrome; 1 patient had progressive systemic sclerosis. Cerebral infarcts occurred in 74% and were recurrent in 37%. Systemic ischemic events, most commonly deep vein thrombosis, occurred in 37%. Tobacco use was documented in 85%, hyperlipidemia in 74%, hypertension in 44%, and diabetes mellitus in 7% of patients. A prominent headache history was present in 67%. Lupus anticoagulant (LA) was present in 72%, approximately one half had positive antinuclear antibodies and thrombocytopenia, and one quarter had a false-positive VDRL. We compared mean GPL levels in patients testing positive for specific laboratory features of antiphospholipid syndrome with those testing negative for these parameters. Only the LA(+) group had a significantly higher mean GPL than the LA(-) group (P=0.006). Brain imaging showed nonlacunar infarcts in 73% and lacunes in 12%. Of 19 cerebral angiograms, 5 (26%) showed large-vessel occlusive disease and 6 (32%) branch obstruction. Echocardiograms were abnormal in 75%: thickened left-sided valves in 33% and vegetations in 12%. Recurrent cerebrovascular ischemic events were observed in 96%, with transient events (mean rate, 25%/y) occurring 5 times more frequently than strokes (mean rate, 5%/y). Using a standardized disability scale blinded to aCL titer, neurological impairment was severe in 7%, moderate in 30%, and mild or nonexistent in 63%, and unrelated to mean GPL value (P=0.567). Titers fluctuated greatly for individual patients, and most did not consistently test as highly positive. An analysis of fluctuation in symptom severity with concurrent GPL values did not show a statistically significant correlation. Compared with historical controls having a wide range of positive titers, the presence of high IgG aCL titers did not confer a worse prognosis for disability and recurrent ischemic events.
Conclusions:
Our data suggest that cerebrovascular events associated with high positive GPL are frequently multiple and minor (with no disability-titer correlation), present in relatively young patients, and often associated with tobacco abuse, hyperlipidemia, LA, systemic ischemic events, and occult cardiac disease.