Cardiac and cerebral manifestations in patients with antiphospholipid syndrome

We describe cardiac and cerebral manifestations in 27 patients with the antiphospholipid syndrome and give a review of the literature. Patients and methods We studied 27 patients with either cardiac, cerebral or both manifestations, who also were diagnosed with the antiphospholipid syndrome (APS). All patients fulfilled the proposed classification criteria for the APS according to the Scientific Standardisation Committee of the International Society of Thrombosis and Haemostasis (1). Three patients died. Results Eighteen of the 27 patients had coronary artery disease with either thrombotic coronary occlusions, high grade stenosis or complete vessel occlusion. In three patients the left main artery was involved. Ten patients had involvement of the left anterior descending artery (LAD), 6 patients of the circumflex artery (RCX) and 5 patients had involvement of the right coronary artery (RCA). As valvular lesions have been described in association with the APS it should be noted that in 16 cases there was mitral- and/or aortic valve disease and in 3 cases tricuspid valve disease. Four patients underwent mitral- and/or aortic and/or tricuspid valve replacement. 7 patients presented with a history of cerebrovascular involvement; 5 of these patients had cerebral infarction, one patient recurrent cerebral bleeding under oral anticoagulation and another patient presented with cognitive disorders. Three of the 7 patients had a prior history of myocardial infarction, whereas 3 patients underwent mitral or aortic valve replacement. Conclusion The frequent occurrence of coronary disease, cardiac valvular disease and cerebral disease in patients diagnosed with APS may suggest a causative relationship between the presence of PL antibodies and vascular disease.