Background:Antiphospholipid syndrome (APS) as an independent factor in different forms of coronary heart disease (CHD) has been attracting more attention in recent years [1]. The prevalence of AFS in the general population is low (1-5%) but among patients with acute coronary syndrome it ranges from 6.1% to 43.3%. The persistence of high titers of antiphospholipid (aPL) antibodies, especially antibodies to cardiolipin, accelerates the development of endothelial dysfunction and atherothrombotic lesions of the coronary arteries, worsens the course of acute myocardial infarction. It has been experimentally demonstrated that aPL antibodies can directly affect myocardial status through pro-apoptotic signaling pathways and increased cardiomyocyte apoptosis [2].The impact of aPL antibodies on the course of postinfarction myocardial remodeling in patients with CHD has not been established.Objectives:To study the prevalence of APS components in men with stable CHD with postinfarction cardiosclerosis and to evaluate the relationship with structural and functional state of left ventricular myocardium.Methods:164 patients with CHD with postinfarction cardiosclerosis were examined (100% males at the average age of 53,0±9,14 (M±σ)). The diagnosis of CAD was made according to the recommendations of the ANA / ACC (2014) and ESC (2013). The content of IgG and IgM of aPL antibodies - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate and levels of IgG and IgM to β2-glycoprotein I (β2-GP-I) in the blood serum were determined by ELISA. Echocardiography in M-, B- and D-modes was performed.Results:Among 164 patients with post-infarction cardiosclerosis: 75% had Q myocardial infarction (MI), 10.4% had recurrent MI, 7.9% had a stroke or transient ischemic attack and 4.2% had livedo reticularis. 93 (56.7%) patients had positive levels of total aPL antibodies and antibodies to β2-GP-I of IgG class (58 (35,4%) patients had low positive levels of antibodies, 35 (21.3%) patients had medium positive levels of one or both types of antibodies. Positive levels of aPL antibodies and antibodies to β2-GP-I of IgM were detected in 11.6% of patients. Positive levels of aPL antibodies and antibodies to β2-GP-I were more commonly found in men who had Q MI (OR 2.58 95% CI 1.26 - 5.28) and recurrent MI (OR 2.52 95% CI 0.83 - 7.67). Increases of levels of aPL antibodies and antibodies to β2-GP-I correlated with an increase of left ventricle (LV) mass index (r = 0.259 and 0.331, p <0.001). In patients with positive levels of antibodies of IgG to β2-GP-I in postinfarction LV remodeling was more likely to occur by concentric type of hypertrophy of LV than in patients with negative levels of antibodies to β2-GP-I (OR 6.50, 95% CI 2.49 - 16.9, p <0.001). Hypertension had no significant differences within these groups.Conclusion:The risk of persisting positive levels of aPL antibodies and antibodies to β2-GP-I in the postinfarction period is significantly increased in men who had Q MI. Patients with CHD with positive antibodies to β2-GP-I of IgG are associated with an increased risk of postinfarction LV myocardial remodeling by concentric type of hypertrophy of LV.References:[1]Kolitz, T., Shiber, S., Sharabi, I., Winder, A., & Zandman-Goddard, G. (2019). Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Frontiers in immunology,10, 941.[2]Bourke, L. T., McDonnell, T., McCormick, J., Pericleous, C., Ripoll, V. M., Giles, I., ... & Ioannou, Y. (2018). Antiphospholipid antibodies enhance rat neonatal cardiomyocyte apoptosis in an in vitro hypoxia/reoxygenation injury model via p38 MAPK.Cell death & disease,8(1), e2549-e2549.Disclosure of Interests:None declared
Is there a role for immunosuppression in antiphospholipid syndrome?
