Valvular Heart Disease in Antiphospholipid Syndrome
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Heart valve disease (HVD) is the most frequent cardiac manifestation in patients with antiphospholipid syndrome (APS), with prevalence of 30 %. The definition is based on the presence of thickening or vegetation of the valves (mainly mitral and aortic) as described by Libman and Sacks for patients with systemic lupus erythematosus (SLE). Transthoracic and/or transoesophageal echocardiography (TTE and TEE, respectively) enable early and accurate diagnosis and help avoid misdiagnosis as rheumatic valve disease. The presence of antiphospholipid antibodies (aPL) in SLE patients is associated with a threefold greater risk of HVD, confirming the crucial importance of these antibodies in the pathogenic process, leading to thrombotic manifestations on valves because of hypercoagulability. Natural history is characterized by worsening of HVD over time with an increased risk for stroke. APS patients undergoing valve-replacement surgery are at high risk of thrombotic and bleeding complications. Thus aPL-associated HVD has affects clinical management of APS patients.
KeywordsAntiphospholipid syndrome Antiphospholipid antibodies Systemic lupus erythematosus Heart valve disease Libman–Sacks endocarditis Non-bacterial endocarditis Mitral valve Aortic valve Valve thickening Valve dysfunction Rheumatic disease Trans-thoracic echocardiography Trans-oesophageal echocardiography Thrombo-embolic event Stroke Anticoagulant Antiplatelet therapy Cardiac surgery Thrombosis Bleeding
Conflicts of interest
Stéphane Zuily declares that he has no conflict of interest.
Olivier Huttin declares that he has no conflict of interest.
Shirine Mohamed declares that she has no conflict of interest.
Pierre-Yves Marie declares that he has no conflict of interest.
Christine Selton-Suty declares that she has no conflict of interest.
Denis Wahl declares that he has no conflict of interest.
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