Valvular Heart Disease in the Primary Antiphospholipid Syndrome

Abstract

▪ Objective: To determine the prevalence of cardiac valvular involvement in patients with the primary antiphospholipid syndrome.

▪ Design: Cross-sectional study with evaluation of case patients and control patients by Doppler echocardiography. The mean follow-up for case patients was 21 months.

▪ Setting: University-based tertiary medical center.

▪ Patients: Twenty-eight consecutive patients who were diagnosed with the primary antiphospholipid syndrome during a 10-year period; 28 age- and sex-matched healthy controls.

▪ Measurements and Main Results: Ten patients (36%; 95% Cl, 19% to 56%) with the primary antiphospholipid syndrome had cardiac valvular involvement: Four patients had mitral valve involvement; four patients, aortic valve involvement; and two patients, both mitral and aortic valve involvement; no patients had tricuspid or pulmonary valve disease. Eight of 10 patients had a regurgitant murmur. None of the control patients had valvular disease. The mean mitral valve thickness in patients with mitral valve involvement was 7.0 ± 1.6 mm, compared with 2.7 ± 0.8 mm in patients with normal valves and 3.2 ± 0.9 mm in the control group. The mean aortic valve thickness in patients with aortic valve involvement was 3.8 ± 0.5 mm compared with 1.4 ± 0.3 mm in patients with normal valves and 1.4 ± 0.5 mm in the control group. Stenotic lesions were not found. Regurgitation was severe in two patients (one required surgery), moderate in three patients, and mild in three patients.

▪ Conclusions: Valvular involvement is frequently found in patients with the primary antiphospholipid syndrome. The lesions are left-sided, causing regurgitation that may be clinically important.