Left ventricular diastolic abnormalities other than valvular heart disease in antiphospholipid syndrome: An echocardiographic study Antonella Tufano a , Maria Lembo b , Matteo Nicola Di Minno c , Assunta Nardo a , Roberta Esposito b , Ciro Santoro b , Agostino Buonauro b , Anna Maria Cerbone a , Giovanni Di Minno a , Maurizio Galderisi b, ⁎ a Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy b Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy c Department of Translational Medical Sciences, Federico II University, Naples, Italy abstract article info Article history: Received 12 March 2018 Received in revised form 11 April 2018 Accepted 14 May 2018 Background: Antiphospholipid syndrome (APS) can be primary or secondary to other autoimmune disorders. Be- sides valvular heart disease (VHD) and coronary artery disease (CAD), little is known about the impact of APS on left ventricular (LV) function. Methods: After excluding CAD, relevant VHD and heart failure, 69 patients (mean age = 43.9 years, 40 with pri- mary and 29 with secondary APS) were assessed by echo-Doppler. Sixty-nine heathy controls, matched for age and sex, formed the control group. APS was diagnosed in presence of at least one clinical criteria and one con- firmed laboratory criteria, including lupus anticoagulant (LA) titre. The adjusted global APS score (aGAPSS), de- rived from the combination of risk factors for thrombosis and autoimmune-antibody profile was calculated. Results: Patients had similar blood pressure and heart rate, but higher body mass index (BMI) than controls. LV mass index (p = 0.007) and left atrial volume index (p b 0.01) were greater, while early diastolic velocity (e′) was lower (p = 0.003) and E/e′ higher (p = 0.007) in APS. Primary APS patients had lower E/A and e′ compared to both controls and secondary APS, while E/e′ was higher in secondary APS than in controls. APS patients with diastolic dysfunction were older but did not differ for risk factors prevalence from those with normal/indetermi- nate diastolic function. In the pooled APS, LA positivity was independently associated with e′ and E/e′ after adjusting for age, BMI and aGAPSS in separate multivariate models. Conclusion: In APS, LV diastolic abnormalities are detectable. They are more pronounced in primary APS and in- dependently associated with LA positivity. © 2018 Elsevier B.V. All rights reserved. Keywords: Antiphospholipid syndrome Doppler-echocardiography Antiphospholipid antibodies Lupus anticoagulant Diastolic function Left ventricular filling pressures 1. Introduction Antiphospholipid syndrome (APS) is a multisystem autoimmune dis- ease, also involving the heart. It is characterized by high risk of thrombotic and/or obstetric events [1,2] and the presence of antiphospholipid anti- bodies (aPL), particularly anticardiolipin antibodies (aCL), and/or anti- β2-glycoprotein-1 antibodies (aβ2GPI), and/or lupus anticoagulant (LA). APS can be primary or secondary to other systemic autoimmune diseases, mainly systemic lupus erythematosus (SLE) [3]. The most frequent and mainly investigated cardiac manifestation of APS includes valvular heart disease (VHD), which becomes evident in both APS and SLE and encompasses a wide range of clinical manifesta- tions, from totally asymptomatic conditions to overt disease requiring surgical corrections [4,5]. Coronary artery disease (CAD) is another well-known complication in APS patients, it being due to several mechanisms such as coronary thromboembolism, accelerated athero- sclerosis and microvascular injury [5,6]. Thromboembolic manifesta- tions can also develop and lead to pulmonary arterial hypertension and subsequent right ventricular dysfunction/failure [7]. Little information is available about the development of left ventric- ular (LV) dysfunction and overt heart failure in patients affected by APS [8]. In general, primary APS appears to be associated with LV diastolic dysfunction, whereas secondary APS and SLE with an impairment of LV systolic function [9]. Old studies identified impairment of LV diastolic function, again evident in both APS (particularly primary) and SLE [10–13]. These diastolic abnormalities were assessed by standard Dopp- ler echocardiography and included transmitral E/A ratio reduction with increased contribution of atrial systole to global LV filling and prolonga- tion of both E velocity deceleration time and isovolumic relaxation time. LV diastolic dysfunction may be due to a direct effect of antibodies on myocardial walls or to myocardial ischemia (occurring because of coro- nary artery stenosis or coronary microvascular injury) and appears to be more evident in patients with long disease duration [8]. However, in ab- sence of VHD or CAD, the existence of LV dysfunction of APS remains International Journal of Cardiology 271 (2018) 366–370 ⁎ Corresponding author at: Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, Via Pansini 5, 80131 Naples, Italy. E-mail address: mgalderi@unina.it (M. Galderisi). https://doi.org/10.1016/j.ijcard.2018.05.040 0167-5273/© 2018 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard