Session Title: Antiphospholipid Syndrome
Session Type: Abstract Submissions (ACR)
Background/Purpose: Premature atherosclerosis in PAPS is still a matter of debate
Patients and Methods: To determine the prevalence of ischemic heart disease in PAPS patients. Inclusion criteria: Patients ≥18 years of age included in the Patients Registry of the Department of Immunology and Rheumatology from our Institution with the diagnosis of PAPS (Sydney and Alarcón-Segovia et al classifications criteria). All patients gave their written informed consent. Exclusion criteria: creatinine >1.5 mg/dl, BP persistently >150/90 in spite of treatment, diabetes mellitus (I or II), dyslipidemia, SLE, positive anti-dsDNAcd (ELISA), positive antinucleosome antibodies (ELISA), asthma and/or pregnancy. All patients had a coronary CAT scan both at rest and under stress myocardial perfusión with adenosine (140 µg/kg/min for 3 minutes) with a 64 channel tomograph (G.E Milwaukee, USA). We also determined new aCL (IgG, IgA e IgM), anti-β2GP-I (IgG, IgM e IgA), anti-dsDNA and anti-nucleosomes (all by ELISA). Lipid profile and serum creatinine were also newly determined. Our study was approved by the IRB of our Institution.
Results: We studied 24 patients (15 women) with PAPS with a mean age of 29 ± 9.8 years at time of study and 9.5 ± 5.5 years of disease duration. None of them had a history of coronary symptoms. We found that 14/24 patients (58%) had abnormal myocardial perfusion under stress with adenosine, 95% of them with normal coronary arteries. No valvular abnormalities were found. Only one patient (4%) had a previous EKG with ischemic abnormalities. The BMI for the whole group was 26.1 ± 4.5 kg/m2 and 54% had history of cigarette consumption (TI= 9.7 ± 3.2). aCL y anti-β2GP-I (any isotype) were positive in 86 and 96% of cases, respectively. We confirmed that no patient had positive anti-DNA, antinucleosomes nor hyperlipidemia.
Conclusion: We found no direct evidence of epicardial coronary atherosclerosis with aPL in PAPS patients, even after 10 years of follow-up. We also show a high prevalence of abnormal myocardial perfusión (58%) in PAPS patients with normal epicardial coronary arteries. Our study suggests silent myocardial ischemia perhaps due to endothelitis and/or microthrombosis in patients with primary antiphospholipid syndrome.
A. R. Cabral,
C. A. Núñez-Alvarez,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/silent-ischemic-heart-disease-in-patients-with-primary-antiphospholipid-syndrome/