Right ventricular diastolic dysfunction in patients with anticardiolipin antibodies and antiphospholipid syndrome

Objective-To evaluate the prevalence of diastolic dysfunction in patients w ith anticardiolipin antibodies (aCL) and to examine whether the antiphospho lipid syndrome (APS) is associated with diastolic dysfunction independently of valvular abnormalities and systolic dysfunction. Methods-Pulsed, continuous, colour Doppler echocardiography was performed i n 179 subjects, of whom 15 were excluded from the analysis because of systo lic dysfunction or severe valvular disease. The remaining 164 subjects incl uded 29 patients with primary APS, 26 patients with secondary APS (APS in t he presence of systemic lupus erythematosus (SLE)), and 30 patients with SL E and aCL but without BPS; 43 patients with SLE without aCL and 36 normal v olunteers served as control groups. Results-The groups compared differed significantly in all measures of right ventricular function. There was a gradation of increasing diastolic functi on impairment as manifested by prolonged deceleration time (DT) and isovolu mic relaxation time (IVRT) across the groups of patients with SLE without a CL, SLE with aCL, secondary APS, and primary APS. Differences in left ventr icular diastolic function measures were less prominent. in regression analy sis, DT increased by 19.6 ms (p=0.002) in the presence of primary APS and b y 20.1 ms (p=0.038) in the presence of pulmonary hypertension. The titre of IgG aCL was the strongest predictor of a prolonged IVRT. Conclusion-Diastolic dysfunction, in particular of the right ventricle-that is, independent of valvular disease and systolic dysfunction, is a promine nt feature of APS and may be related to the pathogenesis of the syndrome.