Coletto, L. A., Gerosa, M., Valentini, M., Cimaz, R., Caporali, R., Meroni, P. L. and Chighizola, C. B. (2022) Myocardial involvement in anti-phospholipid syndrome: Beyond acute myocardial infarction. Autoimmunity Reviews, 21(3), 102990. (doi: 10.1016/j.autrev.2021.102990) (PMID:34740852)
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Abstract
Anti-phospholipid antibodies (aPL) are the serological biomarkers of anti-phospholipid syndrome (APS), an autoimmune disorder characterized by vascular events and/or pregnancy morbidity. APS is a unique condition as thrombosis might occur in arterial, venous or capillary circulations. The heart provides a frequent target for circulating aPL, leading to a wide variety of clinical manifestations. The most common cardiac presentation in APS, valvular involvement, acknowledges a dual etiology comprising both microthrombotic and inflammatory mechanisms. We describe the cases of 4 patients with primary APS who presented a clinically manifest myocardiopathy without epicardial macrovascular distribution. We propose that microthrombotic/inflammatory myocardiopathy might be an overlooked complication of high-risk APS. As extensively hereby reviewed, the literature provides support to this hypothesis in terms of anecdotal case-reports, in some cases with myocardial bioptic specimens. In aPL-positive subjects, microthrombotic/inflammatory myocardial involvement might also clinically manifest as dilated cardiomyopathy, a clinical entity characterized by ventricular dilation and reduced cardiac output. Furthermore, microthrombotic/inflammatory myocardial involvement might be subclinical, presenting as diastolic dysfunction. Currently, there is no single clinical or imaging finding to firmly confirm the diagnosis; an integrated approach including clinical history, clinical assessment, laboratory tests and cardiac magnetic resonance should be pursued in patients with suggestive clinical presentation.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Coletto, Ms Lavinia |
| Authors: | Coletto, L. A., Gerosa, M., Valentini, M., Cimaz, R., Caporali, R., Meroni, P. L., and Chighizola, C. B. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Infection & Immunity |
| Journal Name: | Autoimmunity Reviews |
| Publisher: | Elsevier |
| ISSN: | 1568-9972 |
| ISSN (Online): | 1873-0183 |
| Published Online: | 02 November 2021 |
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