Abstract: Primary Antiphospholipid Syndrome: A 5-Year Transesophageal Echocardiographic Followup Study

Primary Antiphospholipid Syndrome: A 5-Year Transesophageal Echocardiographic Followup Study

NILDA ESPINOLA ZAVALETA, ROSA MARÍA MONTES, MARÍA ELENA SOTO, NIDIA AVILA VANZZINI, and MARY-CARMEN AMIGO

ABSTRACT.

Objective. To study valvular abnormalities in patients with primary antiphospholipid syndrome (APS) assessed by transesophageal echocardiography (TEE).

Methods. This was a 5-year followup study. Between 1995 and 1997, 29 consecutive patients with primary APS were studied by TEE. Twenty-four patients were evaluated in our institution and 5 were referred from elsewhere. Four patients had died, 12 patients had the 5-year followup TEE, and 8 failed to report for the study.

Results. In the first TEE, valve lesions were found in 17 patients (70.8%), myocardial infarction in 5 cases (29.4%), pulmonary hypertension in 4 (23.5%), and a calcified thrombus in the right atrium in one patient. Five-year followup TEE was performed in 12 patients. Valve lesions were unchanged in 3 cases, and in one of them a new apical akinesis of the left ventricle appeared. New valve lesions were detected in 3 patients. In 6 patients, the valve lesions had progressed and in 2, abnormalities of ventricular wall motion had appeared.

Conclusion. In this highly selected population of patients with primary APS, the predominant cardiac lesion was a noninfective valve lesion. Oral anticoagulant treatment and aspirin proved ineffective in terms of valvular lesion regression. Altogether, myocardial infarction occurred in 9 (37.5%) patients. All had coronary angiography and coronary arteries were normal in 6. (J Rheumatol 2004;31:2402-7)

Key Indexing Terms:

PRIMARY ANTIPHOSPHOLIPID SYNDROME
ECHOCARDIOGRAPHY
VALVE LESIONS
ISCHEMIC HEART DISEASE

From the Department of Echocardiography and Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.

N.E. Zavaleta, MD, PhD, Department of Echocardiography; R.M. Montes, MD; M.E. Soto, MD, Department of Rheumatology; N.A. Vanzzini, MD, Department of Echocardiography; M-C. Amigo, MD, Department of Rheumatology.

Address reprint requests to Dr. N. Espinola Zavaleta, Echocardiography Department, Instituto Nacional de Cardiología "Ignacio Chávez," Juan Badiano No. 1, México, DF 14080, Mexico.

Submitted December 17, 2003; revision accepted June 21, 2004.