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Evaluation of cardiac abnormalities and embolic sources in primary antiphospholipid syndrome by transesophageal echocardiography

Internal Medicine II, University of Milan, L Sacco Hospital, Via GB Grassi 74, 20157 Milan, Italy. Tel: (+ 39) 02 390 425 42; Fax: (+ 39) 02 356 463 0; mauriziot{at}fisiopat.sacco.unimi.it

S Muzzupappa

B Gottardi

C Crema

Internal Medicine II; 'L Sacco' Hospital, University of Milan, Milan, Italy

P Sarzi-Puttini

Rheumatology Unit; 'L Sacco' Hospital, University of Milan, Milan, Italy

E Rossi

Transfusion Medicine, 'L Sacco' Hospital, University of Milan, Milan, Italy

Objective: Valvular lesions are frequently present in Primary Antiphospholipid Syndrome (PAPS) patients using transthoracic and/or transesophageal echocardiography. The aim of this study was to describe the prevalence of cardiac abnormalities (valvular thickening and/or regurgitation) or potential embolic sources (spontaneous echocontrast and/or vegetations) in PAPS patients.

Methods: Multiplane transesophageal echocardiography was performed consecutively on 40 PAPS patients: 17 of them with thrombocytopenia, 27 with at least one thromboembolic event (stroke, transient ischaemic attack, arterial and/or venous thrombosis, pulmonary embolism) and 14 with recurrent fetal loss.

Design: Cardiac involvement (cardiac abnormalities and/or embolic sources) was present in 33/40 (82%) of PAPS patients. According to aCL titer these lesions were revealed in 17/24 (71%) of patients with aCL < 40 GPL-U, while these lesions were present in 100% of patients with aCL > 40 GPL-U. Three patients presented mitral stenosis and 3 non-infective valve masses or vegetations. Embolic sources were found in 4/24 (17%) patients with aCL <40 GPL-U, while they were observed in 6/16 (37%) of patients with titer of aCL >40 GPL-U (X² - 10.03, P <0.01). Regression analysis showed a positive correlation between mitral valve thickening and aCL antibodies titer (r= 0.5; P<0.001).

Conclusions: Valvular lesions are commonly found in PAPS patients. Our data showed a significant correlation among aCL titer, mitral leaflets thickening and thromboembolic events.

Key Words: primary antiphospholipid syndrome • bodies • embolic sources

Lupus, Vol. 9, No. 6, 406-412 (2000)
DOI: 10.1191/096120300678828532


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