Coudray N, de Zuttere D, Blétry O, Piette J C, Wechsler B, Godeau P, Pourny J C, Lecarpentier Y, Chemla D
INSERM U426-Service d'Explorations Fonctionnelles, Hôpital Bichat, Paris, France.
Br Heart J. 1995 Nov;74(5):531-5. doi: 10.1136/hrt.74.5.531.
High titres of serum antiphospholipid antibodies are a possible pathogenic factor for cardiac lesions in patients with systemic lupus erythematosus.
To test the hypothesis of a causal link between high titres of antiphospholipid antibodies in the serum and myocardial involvement in patients without systemic lupus erythematosus.
18 patients with primary antiphospholipid syndrome (recurrent fetal loss, arterial and/or venous thrombosis, high titres of antiphospholipid antibodies, and no criteria for systemic lupus erythematosus) were prospectively studied by cross sectional, M mode, and pulsed Doppler echocardiography, and compared with 18 healthy controls. The pulsed Doppler indices of left ventricular diastolic function included isovolumic relaxation time and four mitral outflow indices: peak velocity of early flow, peak velocity of late flow, early to late peak flow velocity ratio, and rate of deceleration of early flow. Four computerised M mode indices were also measured: peak rate of left ventricular enlargement in diastole, peak rate of posterior wall thinning, peak velocity of lengthening of the posterior wall, and velocity of circumferential chamber lengthening.
Compared with controls, patients with primary antiphospholipid syndrome had higher values for isovolumic relaxation time and peak velocity of late mitral outflow and lower values for early to late mitral peak outflow velocity ratio, rate of deceleration of early mitral outflow, peak rate of left ventricular enlargement in diastole, peak rate of posterior wall thinning, peak velocity of lengthening of the posterior wall and velocity of circumferential chamber lengthening.
This abnormal pattern reflects an impairment of myocardial relaxation and filling dynamics of the left ventricle in patients with primary antiphospholipid syndrome who were free of any clinically detectable heart disease. These data suggest that high serum titres of antiphospholipid antibodies may be associated with subclinical myocardial damage.
血清抗磷脂抗体高滴度是系统性红斑狼疮患者心脏病变的一个可能致病因素。
检验血清中抗磷脂抗体高滴度与无系统性红斑狼疮患者心肌受累之间存在因果关系的假设。
对18例原发性抗磷脂综合征患者（反复流产、动脉和/或静脉血栓形成、抗磷脂抗体高滴度且无系统性红斑狼疮标准）进行前瞻性研究，采用横断面、M型和脉冲多普勒超声心动图检查，并与18名健康对照者进行比较。左心室舒张功能的脉冲多普勒指标包括等容舒张时间和四个二尖瓣流出指标：早期血流峰值速度、晚期血流峰值速度、早期与晚期峰值血流速度比值以及早期血流减速速率。还测量了四个计算机化M型指标：舒张期左心室扩大峰值速率、后壁变薄峰值速率、后壁延长峰值速度以及心室圆周延长速度。
与对照组相比，原发性抗磷脂综合征患者的等容舒张时间和二尖瓣晚期流出峰值速度较高，而二尖瓣早期与晚期峰值流出速度比值、二尖瓣早期流出减速速率、舒张期左心室扩大峰值速率、后壁变薄峰值速率、后壁延长峰值速度以及心室圆周延长速度较低。
这种异常模式反映了无任何临床可检测心脏病的原发性抗磷脂综合征患者左心室心肌舒张和充盈动力学受损。这些数据表明，血清抗磷脂抗体高滴度可能与亚临床心肌损伤有关。
