Lenz Charles J, Mankad Rekha, Klarich Kyle, Kurmann Reto, McBane Robert D
Gonda Vascular Center, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
J Thromb Haemost. 2020 Jun;18(6):1408-1414. doi: 10.1111/jth.14798. Epub 2020 Apr 16.
Nonbacterial thrombotic endocarditis (NBTE) is a potential complication of antiphospholipid syndrome (APS) manifesting as noninfectious lesions on one or more cardiac valves. There are limited tools to inform clinicians regarding which APS patients would benefit most from echocardiographic screening for this complication.
We tested the hypothesis that the risk of both prevalent and incident NBTE is directly related to the number of positive laboratory assays for APS.
PATIENTS/METHODS: In this single-center, retrospective, cohort study design, consecutive patients with confirmed APS seen at Mayo Clinic Rochester, MN (1/1/1993-6/26/2016), were identified by searching a centralized electronic database. Demographic data, clinical presentation, echocardiographic features, laboratory findings, and survival data were scrutinized.
During the study period, 611 patients met the diagnostic criteria for APS and 386 (63%) underwent echocardiography. Of these, 58 (15%) were found to have NBTE. NBTE was more common in those with double (19.4%) and triple-positive laboratory criteria (27.0%) compared with single-positive disease (5.7%, P < .001). Survival free of NBTE diagnosis was significantly shorter in those patients with >1 positive laboratory assay (P < .01). Cox proportional hazard analysis suggests that patients with APS are more likely to be diagnosed with NBTE if they have >1 positive laboratory assay (relative risk 20.1; 95% confidence interval 1.3-316.6; P < .03).
Antiphospholipid syndrome carries a high prevalence of NBTE (15%). This prevalence is particularly high for patients with either double- or triple-positive laboratory criteria.
非细菌性血栓性心内膜炎（NBTE）是抗磷脂综合征（APS）的一种潜在并发症，表现为一个或多个心脏瓣膜上的非感染性病变。目前用于告知临床医生哪些APS患者将从针对该并发症的超声心动图筛查中获益最多的工具有限。
我们检验了这样一个假设，即现患和新发NBTE的风险与APS实验室检测阳性结果的数量直接相关。
患者/方法：在这项单中心、回顾性队列研究设计中，通过检索明尼苏达州罗切斯特市梅奥诊所的一个集中电子数据库，确定了1993年1月1日至2016年6月26日期间在该诊所连续就诊且确诊为APS的患者。对人口统计学数据、临床表现、超声心动图特征、实验室检查结果和生存数据进行了仔细审查。
在研究期间，611例患者符合APS诊断标准，386例（63%）接受了超声心动图检查。其中，58例（15%）被发现患有NBTE。与单项阳性疾病患者（5.7%，P <.001）相比，NBTE在双项（19.4%）和三项实验室标准阳性患者中更为常见（27.0%）。实验室检测结果>1项阳性的患者无NBTE诊断的生存期明显较短（P <.01）。Cox比例风险分析表明，APS患者如果实验室检测结果>1项阳性，则更有可能被诊断为NBTE（相对风险20.1；95%置信区间1.3 - 316.6；P <.03）。
抗磷脂综合征患者中NBTE的患病率很高（15%）。对于实验室标准为双项或三项阳性的患者，这一患病率尤其高。
