Sacré Karim, Brihaye Benoit, Hyafil Fabien, Serfaty Jean-Michel, Escoubet Brigitte, Zennaro Maria-Christina, Lidove Olivier, Laissy Jean-Pierre, Papo Thomas
Bichat-Claude Bernard Hospital, Assistance Publique-Hôpitaux de Paris, and Paris 7 University, Paris, France.
Arthritis Rheum. 2010 Jul;62(7):2093-100. doi: 10.1002/art.27488.
Antiphospholipid syndrome (APS) may cause coronary thrombosis. This study was undertaken to determine the prevalence of silent myocardial disease in patients with APS, using late gadolinium enhancement (LGE) of cardiac magnetic resonance imaging (CMRI).
Twenty-seven consecutive patients with APS and 81 control subjects without known cardiovascular disease underwent CMRI. The prevalence of occult myocardial ischemic disease, as revealed by LGE, was compared between patients with APS and controls, and factors associated with myocardial disease were identified in patients with APS.
Myocardial ischemic disease, as characterized by LGE on CMRI, was present in 8 (29.6%) of 27 patients with APS, and imaging with LGE showed a typical pattern of myocardial infarction (MI) in 3 patients (11.1%). The myocardial scarring revealed on CMRI was not detected by electrocardiography or echocardiography. Although both patients with APS and control subjects shared a low risk of cardiovascular events, as calculated with the Framingham risk equation (mean +/- SD 5.1 +/- 8.2% and 6.5 +/- 7.6%, respectively, for the absolute risk within the next 10 years; P = 0.932), the prevalence of myocardial ischemia was more than 7 times higher in patients with APS (P = 0.0006 versus controls). No association was found between myocardial disease in patients with APS and classic coronary risk factors. The presence of myocardial scarring tended to be more closely associated with specific features of APS, such as duration of the disease, presence of livedo, and positivity for anti-beta(2)-glycoprotein I antibodies.
The finding of a significant and unexpectedly high prevalence of occult myocardial scarring in patients with APS indicates the usefulness of CMRI with LGE for the identification of silent myocardial disease in such patients.
抗磷脂综合征（APS）可能导致冠状动脉血栓形成。本研究旨在利用心脏磁共振成像（CMRI）的延迟钆增强（LGE）来确定APS患者隐匿性心肌疾病的患病率。
连续27例APS患者和81例无已知心血管疾病的对照者接受CMRI检查。比较APS患者和对照者中由LGE显示的隐匿性心肌缺血性疾病的患病率，并确定APS患者中与心肌疾病相关的因素。
27例APS患者中有8例（29.6%）存在CMRI上以LGE为特征的心肌缺血性疾病，LGE成像显示3例患者（11.1%）有典型的心肌梗死（MI）模式。CMRI显示的心肌瘢痕在心电图或超声心动图中未被检测到。尽管根据弗明汉风险方程计算，APS患者和对照者发生心血管事件的风险均较低（未来10年的绝对风险分别为平均±标准差5.1±8.2%和6.5±7.6%；P = 0.932），但APS患者中心肌缺血的患病率比对照者高7倍多（与对照者相比，P = 0.0006）。在APS患者的心肌疾病与经典冠状动脉危险因素之间未发现关联。心肌瘢痕的存在往往与APS的特定特征更密切相关，如疾病持续时间、网状青斑的存在以及抗β2糖蛋白I抗体阳性。
APS患者中隐匿性心肌瘢痕患病率显著且出乎意料地高这一发现表明，CMRI结合LGE对于识别此类患者的隐匿性心肌疾病是有用的。
