Echocardiographic evaluation of patients with primary antiphospholipid syndrome

Am Heart J. 1999 May;137(5):973-8. doi: 10.1016/s0002-8703(99)70424-2.

Abstract

Background: A third to half of the patients with primary antiphospholipid syndrome have valve disease.

Methods and results: The echocardiographic characteristics of primary antiphospholipid syndrome were analyzed, and the utility of treatment with anticoagulants and/or antiplatelet agents (acetylsalicylic acid) is examined with the use of transesophageal echocardiography in the evaluation of valvular lesions after 1 year of therapy. Twenty-nine patients, 22 women and 7 men with average age of 35.4 years, were studied. Transesophageal echocardiography was performed on all patients before beginning anticoagulant and/or antiplatelet treatment. Valve lesions were found in 22 (75.9%) patients. Of these, other cardiac abnormalities were found in 3 cases, myocardial infarction in 2, and atrial septal defect in 1. In 7 (24.1%) cases, no valvular abnormality was detected, although in 1 of these, alterations in left ventricular segmental wall movement secondary to myocardial infarction were found. One year after initiation of anticoagulant and/or antiplatelet therapy, it was possible to perform transesophageal echocardiograms on 13 patients. No modification of valve lesions was found in 6 (46.2%) cases; new lesions had appeared in the remaining 7 (53.8%) as well as left ventricular apical akinesis in 1 case.

Conclusions: These results indicate that the predominant heart lesion in primary antiphospholipid syndrome is valvular; anticoagulant and/or antiplatelet treatment does not diminish the noninfective valve lesions, and on occasion this entity may be associated with myocardial infarction despite angiographically normal coronary arteries.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anticoagulants / therapeutic use
  • Antiphospholipid Syndrome / complications
  • Antiphospholipid Syndrome / diagnostic imaging*
  • Antiphospholipid Syndrome / drug therapy
  • Diagnosis, Differential
  • Drug Therapy, Combination
  • Echocardiography, Transesophageal*
  • Female
  • Follow-Up Studies
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / etiology
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Retrospective Studies

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors