Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.727
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 6, November-December, p. 1199–1205

doi: 10.17219/acem/63753

Publication type: original article

Language: English

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Myocardial Ischaemia, Coronary Atherosclerosis and Pulmonary Pressure Elevation in Antiphospholipid Syndrome Patients

Agnieszka Padjas1,A,B,D,F, Wojciech Płazak2,B,C,D,F, Magdalena Celińska-Lowenhoff1,B, Adam Mazurek2,B, Carlo Perricone3,E, Piotr Podolec2,E, Jacek Musiał1,A,E,F

1 Department of Internal Medicine, Allergy and Immunology, Jagiellonian University Medical College, Kraków, Poland

2 Department of Cardiac and Vascular Diseases, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland

3 Rheumatology Unit, Department of Medicine, Sapienza University, Rome, Italy

Abstract

Background. Thrombotic events in antiphospholipid syndrome (APS) involve venous and arterial circulation with the possible involvement of coronary or pulmonary microcirculation.
Objectives. To evaluate the influence of antiphospholipid antibodies (aPL) and on myocardial ischaemia assessed by single-photon emission computerized tomography (SPECT), coronary atherosclerosis assessed by multidetector computerized tomography (MDCT) and pulmonary pressure assessed by transthoracic echocardiography (TTE) in patients with primary antiphospholipid syndrome (PAPS).
Material and Methods. TTE, SPECT (Tc 99m sestamibi) and MDCT-based coronary calcium scoring were performed in 26 consecutive PAPS patients (20 females, 6 males, aged 20−61, mean 39.7) without any signs of other autoimmunological disease and without clinical symptoms of heart disease.
Results. Out of 26 patients, TEE showed normal left and right ventricle function in 25 (96.2%) and elevated (≥ 30 mm Hg) right ventricle systolic pressure in 7 (26.9%) patients. SPECT revealed myocardial perfusion defects in 15 (57.7%) patients: exercise-induced in 6 (23.1%) and persistent in 11 (42.3%). MDCT revealed coronary calcifications in 4 (15.4%) patients. The number of plaques ranged from 1 to 11 (median 2), volume 3−201.7 mm³ (median 7), calcium scores 1.3–202.6 (median 5.7). In the group with perfusion defects or coronary calcifications (n = 15), all the patients showed elevated aCL IgG.
Conclusion. In most of the relatively young APS patients, without any symptoms of ischemic heart disease, SPECT showed myocardial perfusion defects, and coronary calcifications in 1/6 of them. Right ventricle systolic pressure was elevated in 1/4 of APS patients. These pathologies, well known as cardiovascular risk markers, were associated with elevated levels of the IgG class of both anti-cardiolipin and antiB2 GPI antibodies. Thus, in a high percentage of APS patients, clinically silent myocardial ischaemia, pulmonary pressure elevation and coronary atherosclerosis are present and related to the presence of antiphospholipid antibodies.

Key words

antiphospholipid syndrome, anti-cardiolipin antibodies, anti-beta 2 glycoprotein I antibodies, pulmonary arterial pressure, myocardial ischaemia

References (29)

  1. Miyakis S, Lockshin MD, Atsumi T, Branch DW, Brey RL, Cervera R, Derksen RH, DE Groot PG, Koike T, Meroni PL, Reber G, Shoenfeld Y, Tincani A, Vlachoyiannopoulos PG, Krilis SA: International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Heamost 2006, 4, 295−306.
  2. Ross R: Atherosclerosis − an inflammatory disease. N Engl J Med 1999, 340, 115−126.
  3. Sherer Y, Shoenfeld Y: Antiphospholipid antibodies: Are they proatherogenic or an epiphenomenona of atherosclerosis? Immunobiology 2003, 207, 13–16.
  4. Nityanand S, Bergmark C, de Faire U, Swedenborg J, Holm G, Lefvert AK: Antibodies against endothelial cells and cardiolipin in young patients with peripheral atherosclerotic disease. J Intern Med 1995, 238, 437–443.
  5. Vaarala O, Mänttäri M, Manninen V, Tenkanen L, Puurunen M, Aho K, Palosuo T: Anti-cardiolipin antibodies and risk of myocardial infarction in a prospective cohort of middle-aged men. Circulation 1995, 91, 23−27.
  6. Comarmond C, Cacoub P: Antiphospholipid syndrome: From pathogenesis to novel immunomodulatory therapies. Autoimmun Rev 2013, 12, 752−757.
  7. Cervera R, Piette JC, Font J, Khamashta MA, Shoenfeld Y, Camps MT, Jacobsen S, Lakos G, Tincani A, Kontopoulou-Griva I, Galeazzi M, Meroni PL, Derksen RH, de Groot PG, Gromnica-Ihle E, Baleva M, Mosca M, Bombardieri S, Houssiau F, Gris JC, Quéré I, Hachulla E, Vasconcelos C, Roch B, FernándezNebro A, Boffa MC, Hughes GR, Ingelmo M; Euro-Phospholipid Project Group Antiphospholipid syndrome: Clinical and immunologic manifestations and patterns of disease expression in a cohort of 1,000 patients. Arthritis Rheum 2002, 46, 1019−1027.
  8. Sacré K, Brihaye B, Hyafil F, Serfaty JM, Escoubet B, Zennaro MC, Lidove O, Laissy JP, Papo T: Asymptomatic myocardial ischemic disease in antiphospholipid syndrome: A controlled cardiac magnetic resonance imaging study. Arthritis Rheum 2010, 62, 2093−2100.
  9. Agatson AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R: Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990, 15, 827−832.
  10. Pengo V, Tripodi A, Reber G, Rand JH, Ortel TL, Galli M, De Groot PG: Update of the guidelines for lupus anticoagulant detection. Subcommittee on Lupus Anticoagulant/Antiphospholipid Antibody of the Scientific and Standarisation Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost 2009, 7, 1737−1740.
  11. Plazak W, Pasowicz M, Kostkiewicz M, Podolec J, Tomkiewicz-Pajak L, Musial J, Podolec P: Influence of chronic inflammation and autoimmunity on coronary calcifications and myocardial perfusion defects in systemic lupus erythematosus patients. Inflamm Res 2011, 60, 973−980.
  12. Lin CC, Ding HJ, Chen YW, Wang JH, Ho ST, Kao A: Usefulness of technetium-99m sestamibi myocardial perfusion SPECT in detection of cardiovascular involvement in patients with systemic lupus erythematosus or systemic sclerosis. Int J Cardiol 2003, 92, 157−161.
  13. Espinola-Zavaleta N, Alexanderson E, Granados N, Soto ME, Amigo MC: Myocardial perfusion defects in patients with autoimmune diseases: A prospective study. Analysis of two diagnostic tests. Lupus 2006, 15, 38–43.
  14. Baharfard N, Shiroodi MK, Fotoohi F, Samangooie S, Asli IN, Eghtesadi-Araghi P, Javadi H, Semnani S, Amini A, Assadi M: Myocardial perfusion imaging using a technetium-99m sestamibi in asymptomatic and low risk for coronary artery disease patients with diagnosed systemic lupus erythematosus. Perfusion 2011, 26, 151−157.
  15. Sun SS, Shiau YC, Tsai SC, Lin CC, Kao A, Lee CC: The role of technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) in the detection of cardiovascular involvement in systemic lupus erythematosus patients with non-specific chest complaints. Rheumatology (Oxford) 2001, 40, 1106−1111.
  16. Vanzetto G, Ormezzano O, Fagret D, Comet M, Denis B, Machecourt J: Long term additive prognostic value of thalium-201 myocardial perfusion imaging over clinical and exercise stress test in low to intermediate risk patients: Study in 1137 patients with 6-year follow-up. Circulation 1999, 100, 1521−1527.
  17. Hachamovitch R, Berman DS, Shaw LJ, Kiat H, Cohen I, Cabico JA, Friedman J, Diamond GA: Incremental prognostic value of myocardial perfusion single photon emission computed tomography for the prediction of cardiac death: Differential stratification for risk of cardiac death and myocardial infarction. Circulation 1998, 17, 97, 535−543.
  18. Alexánderson E, Gómez-León A, Vargas A, Romero JL, Sierra Fernández C, Rodriguez Valero M, GarcíaRojas L, Meave A, Amigo MC: Myocardial ischaemia in patients with primary APS: A 13N-ammonia PET assessment. Rheumatology (Oxford) 2008, 47, 894−896.
  19. Kovacs G, Maier R, Aberer E: Borderline pulmonary arterial pressure is associated with decreased exercise capacity in scleroderma. Am J Respir Crit Care Med 2009, 180, 881−886.
  20. Cefle A, Inanc M, Sayarlioglu M, Kamali S, Gul A, Ocal L, Aral O, Konice M: Pulmonary hypertension in systemic lupus erythematosus: Relationship with antiphospholipid antibodies and severe disease outcome. Rheumatol Int 2011, 31, 183−189.
  21. Hasegawa EM, Caleiro MT, Fuller R, Carvalho JF: The frequency of anti-beta2-glycoprotein I antibodies is low and these antibodies are associated with pulmonary hypertension in mixed connective tissue disease. Lupus 2009, 18, 618−621.
  22. Canaud G, Bienaimé F, Tabarin F, Bataillon G, Seilhean D, Noël LH, Dragon-Durey MA, Snanoudj R, Friedlander G, Halbwachs-Mecarelli L, Legendre C, Terzi F: Inhibition of the mTORC pathway in the antiphospholipid syndrome. N Engl J Med. 2014, 371, 303−312.
  23. Yiu KH, Wang S, Mok MY, Ooi GC, Khong PL, Mak KF, Lam KF, Lau CS, Tse HF: Pattern of arterial calcification in patients with systemic lupus erythematosus. J Rheumatol 2009, 36, 2212−2217.
  24. Polonsky TS, McClelland RL, Jorgensen NW, Bild DE, Burke GL, Guerci AD, Greenland P: Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010, 303, 1610−1616.
  25. Uebleis C, Becker A, Griesshammer I, Cumming P, Becker C, Schmidt M, Bartenstein P, Hacker M: Stable coronary artery disease: Prognostic value of myocardial perfusion SPECT in relation to coronary calcium scoring – long-term follow-up. Radiology 2009, 252, 682−690.
  26. Glueck CJ, Lang JE, Tracy T, Sieve-Smith L, Wang P: Evidence that anticardiolipin antibodies are independent risk factors for atherosclerotic vascular disease. Am J Cardiol 1999, 83, 1490−1494.
  27. Le Tonquèze M, Salozhin K, Dueymes M, Piette JC, Kovalev V, Shoenfeld Y, Nassonov E, Youinou PY: Role of β2-glycoprotein I in the antiphospholipid antibody binding to endothelial cells. Lupus 1995, 4, 179−186.
  28. Giron-Gonzales JA, Garcia del Rio E, Rodriguez C, Rodriguez-Martorell J, Serrano A: Antiphospholipid syndrome and asymptomatic carriers of antiphospholipid antibody: Prospective analysis of 404 individuals. J Rheumatol 2004, 31, 1560−1567.
  29. Wahl DG, Bounameaux H, de Moerloose P, Sarasin FP: Prophylactic antithrombotic therapy for patients with systemic lupus erythematosus with or without antiphospholipid antibodies: Do the benefits outweigh the risks? A decision analysis. Arch Intern Med 2000, 160, 2042−2048.