Diastolic dysfunction is a feature of the antiphospholipid syndrome

Recurrent thrombi, thrombocytopenia, pregnancy loss, and stroke in association with medium to high concentrations of anticardiolipin antibodies are well-recognized features of antiphospholipid syndrome. Cardiac manifestations of primary antiphospholipid syndrome (PAPS) also have been documented but involve structural and valvular heart disease. Diastolic dysfunction in PAPS has not been well described. Therefore, 10 patients with PAPS (nine women and one man) of mean age 30 ± 7 years (range 20 to 46 years) and 10 healthy age-, sex-, weight-, and height-matched control subjects were studied by echocardiography. Anticardiolipin antibody concentrations of patients with PAPS were>80 immunoglobulin G phospholipid units as determined by enzyme-linked immunosorbent assay. Doppler-derived parameters of left ventricular filling showed a significant association between PAPS and diastolic dysfunction compared with control, as evidenced by a decrease in peak early filling velocity (52 ± 10 cm/sec vs 67 ± 12 cm/sec; p <0.01), a decrease in the ratio of peak early to peak atrial filling velocities (1.03 ± 0.40 vs 1.52 ± 0.28; p < 0.005), a decrease in the mean deceleration rate of early filling (338 ± 75 cm/sect vs 590 ± 227 cm/sec2; p < 0.005), and an increase in the percentage of atrial contribution to filling and deceleration time. Left ventricular mass, diastolic filling time, and heart rate did not differ between groups. Left ventricular systolic function was normal and ejection fraction did not differ between patients with PAPS and control subjects (63% ± 2% vs 65% ± 7%; p not significant). These data demonstrate that left ventricular diastolic dysfunction in the absence of systolic impairment is a feature of PAPS. Additional studies are needed to determine the potential causative role of anticardiolipin antibodies in diastolic dysfunction of PAPS.