Right ventricular diastolic dysfunction in patients with anticardiolipin antibodies and antiphospholipid syndrome

Abstract

Objective: To evaluate the prevalence of diastolic dysfunction in patients with anticardiolipin antibodies (aCL) and to examine whether the antiphospholipid syndrome (APS) is associated with diastolic dysfunction independently of valvular abnormalities and systolic dysfunction.

Methods: Pulsed, continuous, colour Doppler echocardiography was performed in 179 subjects, of whom 15 were excluded from the analysis because of systolic dysfunction or severe valvular disease. The remaining 164 subjects included 29 patients with primary APS, 26 patients with secondary APS (APS in the presence of systemic lupus erythematosus (SLE)), and 30 patients with SLE and aCL but without APS; 43 patients with SLE without aCL and 36 normal volunteers served as control groups.

Results: The groups compared differed significantly in all measures of right ventricular function. There was a gradation of increasing diastolic function impairment as manifested by prolonged deceleration time (DT) and isovolumic relaxation time (IVRT) across the groups of patients with SLE without aCL, SLE with aCL, secondary APS, and primary APS. Differences in left ventricular diastolic function measures were less prominent. In regression analysis, DT increased by 19.6 ms (p=0.002) in the presence of primary APS and by 20.1 ms (p=0.038) in the presence of pulmonary hypertension. The titre of IgG aCL was the strongest predictor of a prolonged IVRT.

Conclusion: Diastolic dysfunction, in particular of the right ventricle-that is, independent of valvular disease and systolic dysfunction, is a prominent feature of APS and may be related to the pathogenesis of the syndrome.

Figure 1

Box plots for right ventricular parameters, including (A) isovolumic relaxation time, (B) E/A ratio, and (C) deceleration time in the five groups of subjects compared. Box plots show the median (horizontal line) and the interquartile range box, together with whisker lines extending to the highest and lowest value (not showing few outliers of more than 1.5 box lengths from the box). SLE = systemic lupus erythematosus; APS = antiphospholipid syndrome; pAPS = primary APS; SLE/APS = APS secondary to SLE; SLE/aCL = SLE with aCL (without APS); SLE/naCL = SLE without aCL or APS.