Although the antiphospholipid antibodies are well recognized to be associated with
thrombosis, recurrent abortion, and thrombocytopenia in patients with systemic lupus
erythematosus (SLE), their relationship with cardiac disease is less clear. The purpose
of this study was to evaluate the association between anti-phospholipid antibodies
and cardiac abnormalities in patients with SLE.
A total of 75 consecutive SLE patients and 60 healthy sex- and age-matched control
subjects were evaluated in a case-control study. All participants underwent M-mode,
two-dimensional, and Doppler echocardiography. Antiphospholipid antibodies levels
were assayed in each patient. The prevalence of antiphospholipid antibodies in patients
with and without echocardiographic abnormalities was compared.
Compared with the control group, SLE patients had significantly more pericardial abnormalities,
left ventricular hypertrophy, left atrial enlargement, left ventricular dysfunction
and verrucous valvular thickening, global valvular thickening with dysfunction, and
mitral and aortic regurgitation. Among these abnormalities, antiphospholipid antibodies
were significantly associated with isolated left ventricular (global or segmental)
dysfunction (four of five positive; p less than 0.05), verrucous valvular (mitral
or aortic) thickening (seven of nine positive; p less than 0.005), global valvular
(mitral or aortic) thickening and dysfunction (five of six positive; p less than 0.02),
as well as mitral regurgitation (16 of 19 positive; p less than 0.001) and aortic
regurgitation (five of six positive; p less than 0.02).
Valvular lesions and myocardial dysfunction are associated with elevated antiphospholipid
antibodies. This study has important implications for the pathogenic role of anti-phospholipid
antibodies in relation to these cardiac abnormalities.