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

Padjas, Agnieszka; Płazak, Wojciech; Celińska-Löwenhoff, Magdalena; Mazurek, Adam; Perricone, Carlo; Podolec, Piotr; Musiał, Jacek

doi:10.17219/acem/63753

Cited by 14 publications

(5 citation statements)

References 23 publications

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“…Myocardial perfusion defects in APS patients without prior CAD were previously examined by three studies using contrast echocardiography and scintigraphy with radionuclides [30], SPECT [31] and N-ammonia PET [32], respectively. Perfusion abnormalities were detected in 30%, 57.7% and 38.8% of 11, 26, and 18 patients tested, respectively.…”

Section: Discussionmentioning

confidence: 99%

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

Mavrogeni

Markousis‐Mavrogenis

Karapanagiotou

et al. 2019

JCM

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Objective: To examine the prevalence of silent myocardial ischemia and fibrosis in antiphospholipid syndrome (APS), using stress cardiovascular magnetic resonance (CMR). Methods: Forty-four consecutive APS patients without prior cardiac disease (22 primary APS, 22 systemic lupus erythematosus (SLE)/APS, mean age 44 (12.9) years, 64% women) and 44 age/gender-matched controls were evaluated using CMR at 1.5 T. Steady-state free precession imaging for function assessment and adenosine stress-CMR for perfusion-fibrosis evaluation were employed. The myocardial perfusion reserve index (MPRI), and myocardial fibrosis expressed as late gadolinium enhancement (LGE), were evaluated. Coronary angiography was indicated in patients with LGE. Associations with APS characteristics, classic cardiovascular disease (CVD) risk factors, high-sensitivity CRP (hs-CRP) and high-sensitivity Troponin (hs-TnT) levels were tested. All patients were followed up for 12 months. Results: Median MPRI was significantly lower in APS patients versus controls [1.5 (0.9–1.9) vs. 2.7 (2.2–3.2), p < 0.001], independently of any LGE presence. LGE was detected in 16 (36.3%) patients versus none of controls (p < 0.001); 12/16 were subsequently examined with coronary angiography and only two of them had coronary artery lesions. In multivariable analysis, none of the APS-related and classic CVD risk factors, or hs-CRP and hs-TnT covariates, were significant predictors of abnormal MPRI or LGE. At the twelve month follow-up, three (6.8%) patients experienced coronary artery disease, notably those with the lowest MPRI values. Conclusions: Abnormal MPRI and LGE are common in asymptomatic APS patients, independently so of any APS-related and classic CVD risk factors, or coronary angiography findings in cases with LGE. Stress-CMR is a valuable tool to detect silent myocardial ischemia and fibrosis in APS.

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Section: Discussionmentioning

confidence: 99%

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

Mavrogeni

Markousis‐Mavrogenis

Karapanagiotou

et al. 2019

JCM

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“…The general prevalence has been reported to be ap-proximately 5.5% (9). It is worth noting that APS can also be associated with clinically silent MI, elevated pulmonary pressure, and coronary atherosclerosis (10). Interestingly, non-thrombotic MI can be a manifestation of APS through a mechanism involving tissue factor activation by inflammatory markers and aPL (11).…”

Section: N Discussionmentioning

confidence: 99%

Adrenal hemorrhage and non-ST elevation myocardial infarction: an antiphospholipid syndrome dilemma

El Hasbani,

Del Pilar Morel,

Tandoh

et al. 2023

Reumatismo

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Antiphospholipid syndrome (APS) can affect different organ systems, including the heart and adrenal glands. Despite being known for its prothrombotic characteristics, APS can have serious bleeding complications. Occasionally, thrombotic and bleeding episodes can present simultaneously in an APS patient. Whenever these events co-occur, resuming anticoagulation becomes a topic of debate. As such, we present the case of a 43-year-old male with triple positive antiphospholipid antibodies, indicating APS, who presented with chest pain. Anticoagulants were switched one month before presentation from warfarin to a direct oral anticoagulant, rivaroxaban. Non-ST elevation myocardial infarction, as well as new-onset left-sided adrenal hemorrhage, were diagnosed. The patient developed adrenal insufficiency; therefore, corticosteroids were administered, and warfarin was resumed to prevent further thrombotic episodes.

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“…Thus, a significant proportion of patients with APS have clinically silent myocardial ischemia and coronary atherosclerosis, both of which are causally linked to the presence of APL antibodies. This raises the question of how many young patients are at risk [13].…”

Section: Aps and Silent Ischemiamentioning

confidence: 99%

“…Due to accelerated atherosclerosis in such patients, cardiovascular disease (CVD) is the leading cause of death, often progressing more rapidly than the general population [12]. Clinically silent myocardial ischemia, elevated pulmonary pressure, and coronary atherosclerosis are present in a large proportion of APS patients [13,14]. When comparing causes of death, MI was the leading cause, contributing to 19% of deaths in patients with APS over a five-year follow-up period [15].…”

Section: Introductionmentioning

confidence: 99%

Unraveling the Association Between Myocardial Infarction of Nonobstructive Coronary Arteries and Anti-phospholipid Syndrome

Ramjas¹,

Jain²,

Lee³

et al. 2021

Cureus

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The term "myocardial infarction with nonobstructive coronary arteries (MINOCA)" refers to a condition characterized by clinical signs and symptoms consistent with acute myocardial infarction (AMI) (as defined by the third universal definition of infarction) and coronary arteries that are angiographically normal or nearly normal. A prominent source of morbidity and mortality in patients with antiphospholipid syndrome (APS) is thrombotic events. To evaluate whether there is a relation between APS and MINOCA in this research, we did an extensive assessment of the existing research in this field. According to the data, APS was associated with microvascular thrombosis, aberrant lipid metabolism, hypertension, and abnormalities of the coagulation cascade, among other conditions. Based on the available data, we discovered evidence that suggests a relationship between MINOCA and APS patients. It is vital to raise awareness of this concern among the general public. Also required is the development and implementation of diagnostic and targeted treatment guidelines for patients with APS and MINOCA.

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

Cited by 14 publications

References 23 publications

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

Silent Myocardial Perfusion Abnormalities Detected by Stress Cardiovascular Magnetic Resonance in Antiphospholipid Syndrome: A Case-Control Study

Adrenal hemorrhage and non-ST elevation myocardial infarction: an antiphospholipid syndrome dilemma

Unraveling the Association Between Myocardial Infarction of Nonobstructive Coronary Arteries and Anti-phospholipid Syndrome

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