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Role of anticardiolipin antibodies in the pathogenesis of prosthetic valve thrombosis

An observational study

Rolle der Anticardiolipin-Antikörper in der Pathogenese der Thrombose von Herzklappenprothesen

Eine Beobachtungsstudie

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Abstract

Background

Prosthetic valve thrombosis (PVT) is serious complication of valvular replacement surgery, and increased levels of anticardiolipin antibodies (aCL) are associated with thrombosis. The aim of this study was to evaluate the role of aCL in the development of PVT.

Patients and methods

We studied the aCL IgM and IgG levels in 114 patients with PVT and 80 healthy patients with prosthetic valves without PVT or a history of thrombosis. All patients underwent detailed transthoracic, transesophageal echocardiographic and clinical examinations. Blood samples were obtained after transesophageal echocardiography. Tests were repeated 12 weeks apart in patients with aCL IgM or IgG positivity.

Results

The mean age, sex, presence of atrial fibrillation and cardiovascular risk factors, elapsed time after surgery, and prosthetic valve type and location were similar between patients with PVT and those without. Ineffective anticoagulation was significantly higher among patients with PVT (p < 0.001). The aCL IgM values were significantly higher and positive (> 40 MPL) in the PVT group compared with the control group (10.58 ± 15.90 MPL to 3.70 ± 2.30 MPL, p < 0.001; 7.0 to 0 %, p = 0.016, respectively). The aCL IgG values were significantly higher and positive (> 40 GPL) in the PVT group compared with the control group (12.04 ± 17.58 GPL to 3.83 ± 2.56 GPL, p < 0.001 and 7.9 to 0 %, p = 0.01, respectively). According to international consensus documents, 16 patients had antiphospholipid syndrome. Ineffective anticoagulation and aCL IgM and IgG positivity were independent predictors of PVT in logistic regression analysis (multivariate r2= 0.648; p < 0.001, OR= 21.405, 95 %CI= 8.201–55.872; p = 0.008, OR= 1.322, %95CI= 1.076–1.626; p = 0.005, OR= 1.288, 95 %CI= 1.079–1.538).

Conclusion

Since the presence of aCL IgM and IgG positivity may cause a tendency toward PVT, these values should be examined in all patients with PVT.

Zusammenfassung

Hintergrund

Die Thrombose der Herzklappenprothese (“prosthetic valve thrombosis”, PVT) ist eine ernste Komplikation der Klappenersatzchirurgie, mit einer solchen Thrombose gehen erhöhte Werte für Anticardiolipin-Antikörper (aCL) einher. Ziel der vorliegenden Studie ist es, die Rolle von aCL bei der Entstehung einer PVT zu bestimmen.

Patienten und Methoden

Es wurden aCL-IgM und -IgG bei 114 Patienten mit PVT und 80 gesunden Patienten mit Klappenprothesen ohne PVT und ohne Thrombose in der Anamnese bestimmt. Bei sämtlichen Patienten wurden eine ausführliche transthorakale und transösophageale Echokardiographie sowie eine klinische Untersuchung durchgeführt. Nach der transösophagealen Echokardiographie wurden Blutproben entnommen. Bei Patienten mit positivem aCL-IgM und -IgG wurden die Untersuchungen nach 12 Wochen wiederholt.

Ergebnisse

Das Durchschnittsalter, Geschlecht, Vorliegen eines Vorhofflimmerns und kardiovaskulärer Risikofaktoren, Zeit seit der Operation, Art der Klappenprothese und ihre Lokalisation waren für Patienten mit und für Patienten ohne PVT ähnlich. Eine ineffektive Antikoagulation war bei Patienten mit PVT signifikant häufiger (p < 0,001). Der Wert für aCL-IgM war in der PVT-Gruppe im Vergleich zu den Kontrollen signifikant höher (10,58 ± 15,90 Standard-IgM-aCL-Einheiten, MPL bzw. 3,70 ± 2,30 MPL; p < 0,001; 7,0 % bzw. 0 %; p = 0,016) und positiv (> 40 MPL). Der Wert für aCL-IgG war in der PVT-Gruppe im Vergleich zu den Kontrollen signifikant höher (12,04 ± 17,58 Standard-IgG-aCL-Einheiten, GPL bzw. 3,83 ± 2,56 GPL; p < 0,001 und 7,9 % bzw. 0 %; p = 0,01) und positiv (> 40 GPL). Gemäß den Kriterien des internationalen Konsensuspapiers lag bei 16 Patienten ein Antiphospholipidsyndrom vor. Eine infeffektive Antikoagulation sowie positive Werte für aCL-IgM und -IgG waren unabhängige Prädiktoren einer PVT in der logistischen Regressionsanalyse (multivariates r2= 0,648; p < 0,001; OR= 21,405; 95%-KI= 8,201–55,872; p = 0,008; OR= 1,322; 95%-KI= 1,076–1,626; p = 0,005; OR= 1,288; 95%-KI= 1,079–1,538).

Schlussfolgerung

Da das Vorliegen positiver Werte für aCL-IgM und -IgG möglicherweise eine Neigung zur PVT bedingt, sollte dieser Wert bei allen Patienten mit PVT untersucht werden.

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Compliance with ethical guidelines

Conflict of interest. A.C. Aykan, T. Gökdeniz, M. Kalçık, M.A. Astarcıoğlu, S. Gündüz, S. Karakoyun, M.O. Gürsoy, A.E. Oğuz, E. Ertürk, B. Çakal, Z. Bayram, and M. Özkan state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Cardiology, Koşuyolu Kartal Heart Training and Research Hospital, Cevizli Kavsagi, Kartal, 34876, Istanbul, Turkey

    A.Ç. Aykan, T. Gökdeniz, M. Kalçık, M.A. Astarcıoğlu, S. Gündüz, S. Karakoyun, M.O. Gürsoy, A.E. Oğuz, E. Ertürk, B. Çakal, Z. Bayram & M. Özkan

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  1. A.Ç. Aykan
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  2. T. Gökdeniz
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  3. M. Kalçık
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  4. M.A. Astarcıoğlu
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  5. S. Gündüz
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  6. S. Karakoyun
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  7. M.O. Gürsoy
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  8. A.E. Oğuz
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  9. E. Ertürk
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  10. B. Çakal
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  11. Z. Bayram
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Correspondence to A.Ç. Aykan.

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Aykan, A., Gökdeniz, T., Kalçık, M. et al. Role of anticardiolipin antibodies in the pathogenesis of prosthetic valve thrombosis. Herz 40, 528–533 (2015). https://doi.org/10.1007/s00059-013-4038-1

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  • DOI: https://doi.org/10.1007/s00059-013-4038-1

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