Myocardial microangiopathy associated with antiphospholipid antibodies

Myocardial thrombotic microangiopathy is a well described post-mortem findi ng in patients with the catastrophic antiphospholipid (APL) syndrome. Howev er, it has been only very rarely imaged in living patients. Here, we report two patients with APL antibodies presenting with scintigraphic, electrocar diographic and/or echocardiographic evidence of (sub)acute myocardial ischa emia, despite a normal coronary angiography. Formal proof of a thrombotic m icroangiopathy was obtained by a kidney biopsy in one patient. We emphasize the value of Tc-99m-MIBI (2-methoxy isobutyl isonitrile) exercise stress m yocardial scintigraphy for the detection of cardiac microangiopathy associa ted with the APL syndrome.