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Cardiac manifestations in primary antiphospholipid syndrome and their association to antiphospholipid antibodies’ types and titers—cross-sectional study of Serbian cohort

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Abstract

Objectives

Antiphospholipid syndrome (APS) is multisystem autoimmune coagulopathy with antiphospholipid antibodies (aPL) in its ground, manifested as a primary disease (PAPS) or in the setting of other conditions, most commonly systemic lupus erythematosus. The objective of this cross-sectional study was to investigate various cardiac manifestations and their possible relation to aPL type and titer in a Serbian cohort of PAPS patients.

Methods

A total of 360 PAPS patients were analyzed and aPL analysis included detection of anticardiolipin antibodies (aCL: IgG/IgM), anti-ß2glycoprotein I (ß2GPI: IgG/IgM), and lupus anticoagulant (LA). Cardiac manifestations investigated were valvular lesions (comprehending valvular thickening and dysfunction not related to age and pseudoinfective endocarditis), coronary artery disease (CAD) with specific insight for myocardial infarction (MI), chronic cardiomyopathy (CMP), and acute decompensated heart failure (ADHF) as well as pulmonary hypertension (PH) and intracardiac thrombus presence.

Results

The prevalence of cardiac manifestations overall was 19.6%. There was a strong association between age and the majority of cardiac manifestations, as well as standard atherosclerotic risk factors. aCL IgG–positive patients had a higher prevalence of valvular lesions (p = 0.042). LA presence was significantly related to MI (p = 0.031) and PH (p = 0.044). CMP and ADHF were significantly related to higher titers of aCl IgG (p = 0.033, p = 0.025 respectively). Age and smoking were independent risk predictors for MI in PAPS with meaningful risk for LA positivity (OR 2.567 CI 0.671–9.820 p = 0.168).

Conclusions

Certain cardiac manifestations in PAPS were related to certain aPL type and/or titer levels, imposing confirmation in prospective studies. Preventive actions, comprehending proper anticoagulant/antithrombotic therapy, and intense action against standard atherosclerotic risk factors are of utmost importance in this group of patients.

Key Points

• In Serbian patients with primary antiphospholipid syndrome (PAPS), prevalence of non-criteria cardiac manifestations was 19.6% and they were significantly related to certain antiphospholipid antibodies and titers.

• Lupus anticoagulant was a meaningful predictor of myocardial infarction, enabling possible risk stratification and proper preventive and therapeutical strategies in this subgroup of PAPS patients.

• Patients with high titers of aCL IgG are more prone to acute decompensated heart failure occurence, imposing careful follow-up of these patients

• Based on the analysis of the Serbian PAPS cohort, even being non-criterial, cardiology manifestations are significantly present and inclusion of cardiologists in treatment and follow-up of these patients should be implied from the diagnosis establishment.

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Authors and Affiliations

  1. Department of Cardiology, Division of Interventional Cardiology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia

    Aleksandra Djokovic

  2. Faculty of Medicine, University of Belgrade, Belgrade, Serbia

    Aleksandra Djokovic, Branka Filipovic, Predrag Matic & Jovica Saponjski

  3. Department of Rheumatology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia

    Ljudmila Stojanovich

  4. Department of Hematology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia

    Natasa Stanisavljevic

  5. Clinical Center of Serbia, Pulmonology Clinic, Belgrade, Serbia

    Sandra Djokic

  6. Department of Gastroenterology, University Hospital Medical Center Dr Dragisa Misovic - Dedinje, Belgrade, Serbia

    Branka Filipovic

  7. Department of Vascular Surgery, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia

    Predrag Matic

  8. Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia

    Milomir Milanovic

  9. Department of Professional and Scientific Training, Cardiology Clinic, Clinical Center of Nis, Nis, Serbia

    Svetlana Apostolovic

  10. School of Medicine, University of Nis, Nis, Serbia

    Svetlana Apostolovic

  11. Department of Interventional Cardiology, Emergency Room, Clinical Center of Serbia, Belgrade, Serbia

    Jovica Saponjski

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  1. Aleksandra Djokovic
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Correspondence to Aleksandra Djokovic.

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Djokovic, A., Stojanovich, L., Stanisavljevic, N. et al. Cardiac manifestations in primary antiphospholipid syndrome and their association to antiphospholipid antibodies’ types and titers—cross-sectional study of Serbian cohort. Clin Rheumatol 41, 1447–1455 (2022). https://doi.org/10.1007/s10067-022-06056-8

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