DIASTOLIC DYSFUNCTION IS A FEATURE OF THE ANTIPHOSPHOLIPID SYNDROME

Recurrent thrombi, thrombocytopenia, pregnancy loss, and stroke in ass ociation with medium to high concentrations of anticardiolipin antibod ies are well-recognized features of antiphospholipid syndrome. Cardiac manifestations of primary antiphospholipid syndrome (PAPS) also have been documented but involve structural and valvular heart disease. Dia stolic dysfunction in PAPS has not been well described. Therefore, 10 patients with PAPS (nine women and one man) of mean age 30 +/- 7 years (range 20 to 46 years) and 10 healthy age-, sex-, weight-, and height -matched control subjects were studied by echocardiography. Anticardio lipin antibody concentrations of patients with PARS were >80 immunoglo bulin G phospholipid units as determined by enzyme-linked immunosorben t assay. Doppler-derived parameters of left ventricular filling showed a significant association between PAPS and diastolic dysfunction comp ared with control, as evidenced by a decrease in peak early filling ve locity (52 +/- 10 cm/sec vs 67 +/- 12 cm/sec; p < 0.01), a decrease in the ratio of peak early to peak atrial filling velocities (1.03 +/- 0 .40 vs 1.52 +/- 0.28; p < 0.005), a decrease in the mean deceleration rate of early filling (338 +/- 75 cm/sec(2) vs 590 +/- 227 cm/sec(2); p < 0.005), and an increase in the percentage of atrial contribution t o filling and deceleration time. Left ventricular mass, diastolic fill ing time, and heart rate did not differ between groups. Left ventricul ar systolic function was normal and ejection fraction did not differ b etween patients with PAPS and control subjects (63% +/- 2% vs 65% +/- 7%; p not significant). These data demonstrate that left ventricular d iastolic dysfunction in the absence of systolic impairment is a featur e of PARS. Additional studies are needed to determine the potential ca usative role of anticardiolipin antibodies in diastolic dysfunction of PAPS.