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. 2023 Apr 20;12(8):2996.
doi: 10.3390/jcm12082996.

Heart Valve Involvement in Patients with Antiphospholipid Syndrome: A Long-Term Follow-Up Study of a Single Centre

Isaac Pons  1   2   3 , Joana Louro  1   2 , Marta Sitges  2   4   5 , Bàrbara Vidal  2   4   5 , Ricard Cervera  1   2 , Gerard Espinosa  1   2
Affiliations

Heart Valve Involvement in Patients with Antiphospholipid Syndrome: A Long-Term Follow-Up Study of a Single Centre

Isaac Pons et al. J Clin Med. .

Abstract

Background: Valve involvement is the most common cardiac manifestation in antiphospholipid syndrome (APS). The objective of the study was to describe the prevalence, clinical and laboratory features, and evolution of APS patients with heart valve involvement.

Methods: A retrospective longitudinal and observational study of all APS patients followed by a single centre with at least one transthoracic echocardiographic study.

Results: 144 APS patients, 72 (50%) of them with valvular involvement. Forty-eight (67%) had primary APS, and 22 (30%) were associated with systemic lupus erythematosus (SLE). Mitral valve thickening was the most frequent valve involvement present in 52 (72%) patients, followed by mitral regurgitation in 49 (68%), and tricuspid regurgitation in 29 (40%) patients. Female sex (83% vs. 64%; p = 0.013), arterial hypertension (47% vs. 29%; p = 0.025), arterial thrombosis at APS diagnosis (53% vs. 33%; p = 0.028), stroke (38% vs. 21%; p = 0.043), livedo reticularis (15% vs. 3%; p = 0.017), and lupus anticoagulant (83% vs. 65%; p = 0.021) were more prevalent in those with valvular involvement. Venous thrombosis was less frequent (32% vs. 50%; p = 0.042). The valve involvement group suffered from higher mortality (12% vs. 1%; p = 0.017). Most of these differences were maintained when we compared patients with moderate-to-severe valve involvement (n = 36) and those with no or mild involvement (n = 108).

Conclusions: Heart valve disease is a frequent manifestation in our cohort of APS patients and is associated with demographic, clinical and laboratory features, and increased mortality. More studies are needed, but our results suggest that there may be a subgroup of APS patients with moderate-to-severe valve involvement with its own characteristics that differs from the rest of the patients with mild valve involvement or without valve involvement.

Keywords: antiphospholipid antibodies; antiphospholipid syndrome; lupus anticoagulant; valve involvement; valvulopathy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Timeline diagram with evolutive changes of mitral valve involvement.
Figure 2
Figure 2
Timeline diagram with evolutive changes of aortic and tricuspid valve involvement.
Figure 3
Figure 3
Timeline diagram with evolutive changes of normal valves. * More than one valvular lesion or dysfunction occurred in the same patient. Abbreviations: NBTE: non-bacterial thrombotic endocarditis.
See this image and copyright information in PMC

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