Primary antiphospholipid syndrome: a 5-year transesophageal echocardiographic followup study

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.