Cardiac involvement in connective tissue diseases and primary antiphospholipid syndrome: Echocardiographic assessment and correlation with antiphospholipid antibodies

The aim of this study was to determine the incidence of cardiac involvement in systemic lupus erythematosus (SLE), progressive systemic sclerosis (PSS), rheumatoid arthritis (RA) and primary antiphospholipid syndrome (PAPS), and to evaluate the correlation between cardiac involvement and antiphospholipid autoimmunization. M-mode, two-dimensional and Doppler echocardiography was performed in 101 consecutive patients (46 with SLE, 23 with PSS, 12 with RA, 20 with PAPS) and in 20 healthy subjects. None of the patients and of the controls had clinical evidence of cardiac disease. IgG anticardiolipin antibodies (aCL) were measured by an enzyme-linked immunosorbent assay. Valvular lesions were found in 18 SLE patients (39.1%) in 4 PSS patients (17.4%) and in 3 RA patients (25%). In comparison with the control subjects abnormal indexes of left ventricular filling (characterized by a reduced E/A end E/A-VTI ratios, a lower deceleration rate of EF slope and a prolonged IVRT) was only found in patients with connective tissue disease (15.1% in SLE patients, 30% in PSS patients and 40% in RA patients). The presence of aCL was not related to a different prevalence of valve alterations or alterated left ventricular diastolic function. None of the patients with PAPs showed valvular involvement or altered left ventricular filling. It is concluded that cardiac involvement is frequent in patients with connective tissue diseases but is apparently unrelated to increased aCL levels.