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Primary antiphospholipid syndrome as a cause of impaired left ventricular diastolic function: experience from a Serbian cohort

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14

 

  1. University of Belgrade, Faculty of Medicine, Belgrade; and Department of Cardiology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia. drsaska@yahoo.com
  2. University of Belgrade, Faculty of Medicine, Belgrade, and Department of Rheumatology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia.
  3. University of Belgrade, Faculty of Medicine, Belgrade, and Department of Haematology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia.
  4. University of Belgrade, Faculty of Medicine, Belgrade, and Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia.
  5. Department of Cardiology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia.
  6. Department of Cardiology, University Hospital Center Dr Dragisa Misovic Dedinje, Belgrade, Serbia.
  7. University of Belgrade, Faculty of Medicine, Belgrade, and Department of Surgery, University Hospital Center Dr Dragisa Misovic Dedinje, Belgrade, Serbia.
  8. University of Belgrade, Faculty of Medicine, Belgrade, and Department of Vascular Surgery, Institute for cardiovascular diseases Dedinje, Belgrade, Serbia.
  9. University of Belgrade, Faculty of Medicine, Belgrade, and Department of Gastroenterology, University Hospital Center Dr Dragisa Misovic Dedinje, Belgrade, Serbia.
  10. University of Belgrade, Faculty of Medicine, Belgrade, and Department of Interventional Cardiology, Emergency Room, University Clinical Center of Serbia, Belgrade, Serbia.
  11. Department of Professional and Scientific Training, Cardiology Clinic, Clinical center of Nis, and University of Nis, School of Medicine, Nis Serbia.
  12. University of Belgrade, Faculty of Medicine, Belgrade; and Department of Cardiology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia.
  13. Clinic for Pulmonology, University Clinical Center of Serbia, Belgrade, Serbia.
  14. Ariel University, and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.

CER15481
2023 Vol.41, N°1
PI 0103, PF 0109
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PMID: 35485420 [PubMed]

Received: 13/01/2022
Accepted : 04/04/2022
In Press: 20/04/2022
Published: 23/01/2023

Abstract

OBJECTIVES:
Cardiovascular manifestations, encountered in antiphospholipid syndrome, may develop as a consequence of acquired thrombophilia mediated by antiphospholipid antibodies and accelerated atherosclerosis as well. Our study aims to assess the impairment of the left ventricular diastolic performance, as early evidence of myocardial involvement in primary antiphospholipid syndrome (PAPS).
METHODS:
We analysed 101 PAPS patients, with the average age of 47.70±13.14y. Anticardiolipin antibodies (aCL IgG/IgM), anti-ß2 glycoprotein-I (anti-ß2GPI IgG/IgM), and lupus anticoagulant (LAC) were determined. Abnormal cut-off values used for left ventricular diastolic dysfunction (LVDD) were septal E ́<7 cm/sec, lateral E ́ <10 cm/sec, average E/E ́ ratio >14, LA volume index (LAVI) >34 mL/m2, and peak tricuspid regurgitation velocity >2.8 m/sec. LVDD was present if more than half parameters were with abnormal values. The results were compared to 90 healthy, age and sex-matched controls.
RESULTS:
LVDD was significantly more prevalent in PAPS patients compared to healthy controls (24.8% vs. 2.2%, p=0.001). In PAPS patients, it was signi cantly related to age, body mass index, hyperlipidaemia, thromboses and LAC positivity (p=0.0001, p=0.008, p=0.039, p=0.001, p=0.047 respectively). Patients with PAPS had higher LAVI (29.76±6.40 ml/m2 vs. 26.62±7.8 ml/m2, p=0.012), higher isovolumic relaxation time, lower lateral É velocity and lower E/É ratio compared to controls (p=0.0001, p=0.020, p=0.038, respectively). In multivariate analysis, thromboses in PAPS were significant, and independent predictors of LVDD.
CONCLUSIONS:
Thrombotic PAPS patients are at higher risk of LVDD development. Strong action against standard atherosclerotic risk factors and adequate therapy regimes seems to be crucial to preserve good diastolic performance of the left ventricle in PAPS.

DOI: https://doi.org/10.55563/clinexprheumatol/80dkrm

Rheumatology Article