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High Prevalence of Significant Heart Valve Lesions in Patients with the 'Primary' Antiphospholipid Syndrome
Ricard Cervera
Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK
Munther A. Khamashta
Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK
Josep Font
Systemic Autoimmune Diseases Research Unit, Departments of Internal Medicine, Hospital, Clinic, Barcelona, Spain
Pedro A. Reyes
Department of Immunology, Instituto Nacional de Cardiologia, Mexico DF. Mexico
João L. Vianna
Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK
Alfons López-Soto
Systemic Autoimmune Diseases Research Unit, Departments of Internal Medicine, Hospital, Clinic, Barcelona, Spain
Mary-Carmen Amigo
Department of Rheumatology, Instituto Nacional de Cardiologia, Mexico. DF. Mexico
Ronald A. Asherson
Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK
Manuel Azqueta
Department of Cardiology, Hospital Clinic, Barcelona, Spain
Carles Paré
Department of Cardiology, Hospital Clinic, Barcelona, Spain
Jesús Vargas
Department of Echocardiography, Instituto Nacional de Cardiología, Mexico DF. Mexico
Angel Romero
Department of Echocardiography, Instituto Nacional de Cardiología, Mexico DF. Mexico
Miguel Ingelmo
Systemic Autoimmune Diseases Research Unit, Departments of Internal Medicine, Hospital, Clinic, Barcelona, Spain
Graham R.V. Hughes
Lupus Arthritis Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK
A prospective echocardiographic study was carried out on 55 patients with the recently described 'primary' antiphospholipid syndrome derived from three university medical centres. The prevalence of valvular lesions in patients with this syndrome was 38% compared with 4% in a control group of 55 healthy volunteers (P < 0.001). Mean age of patients with valve was 42 ± 12 years and of those without, 30 ± 10 years (P < 0.05). One patient had a morphologic echocardiographic pattern suggestive of non-infective verrucous mitral endocarditis. Twenty patients had a two-dimensional or Doppler echocardiographic pattern of significant valvular dysfunction —either regurgitation or stenosis—without evidence of vegetations. Mitral and aortic regurgitation were the most common lesions in these patients. During follow-up of patients with valvular disease, haemodynamically significant clinical valve disease developed in four and surgery was required in one. Eleven patients had cerebrovascular occlusions. Thus, valvular heart disease, particularly affecting the mitral and aortic valves, is common in patients with the 'primary' antiphospholipid syndrome, especially in. those over 40 years old.
Key Words: Antiphospholipid antibodies • Lupus anticoagulant • Heart valve disease • Echocardiography
Lupus, Vol. 1, No. 1,
43-47 (1991)
DOI: 10.1177/096120339100100108
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