PB0881 - Heart valve diseases in antiphospholipid syndrome: a case report and systematic review

Monday, June 24, 2024

13:45 – 14:45 ICT

Room: Exhibition Hall

Presenting Author(s)

Dabuxilite Bayartaikishigtai

PhD Student
Department of Laboratory Medicine, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)

Co-Author(s)

Shengqiang Pei, PhD

Postdoctoral Researcher
Department of Laboratory Medicine, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)
YS

Yang Sun

Professor
Department of Pathology, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)
LL

Li Li

Professor
Department of Pathology, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)
YZ

Yang Zhang

Professor
Department of Laboratory Medicine, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)
ZZ

Zhou Zhou

Professor
Department of Laboratory Medicine, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College Fuwai Hospital
Beijing, Beijing, China (People's Republic)

Background: In the latest ACR/EULAR APS classification criteria, published last year, valve thickening and valve vegetation were included in the criteria. However, patients with APS (antiphospholipid syndrome) and HVD (heart valve disease) are easily ignored. They have a significantly higher risk of mortality during surgery. Therefore, it is crucial to carefully manage hemostasis and anticoagulation therapy during the perioperative period and after surgery.

Aims: In this study, we presented a case of a patient with APS and mitral regurgitation and provided a systematic review that outlines the clinical characteristics of patients with APS and HVD.

Methods: A systematic search was done in PubMed and Web of Science. The protocol of the systematic review was performed according to the PRISMA methodology. We extracted following variables: age, antibody profile, APS duration, heart valve disease, past medical history, cause of hospitalization, other disease and abnormalities, surgery, medication before hospitalization, immune-related drugs, outcome and follow-up.

Results: We included 75 cases in 70 case reports. Before hospitalization for HVD, twenty-eight (71.79% ‌28/39) patients were unaware that they had APS. Fifty-four patients with recorded antibody profiles. The most common antibody in these cases was lupus anticoagulant. Twenty patients’ antiphospholipid antibody profiles were triple positive. The most commonly involved valve is the mitral valve. Four patients had adverse outcomes.

Conclusion(s): Patients with both APS and HVD are easily disregarded. Most of these patients who present for HVD were unaware that they had APS. Patients with APS and HVD should receive additional attention due to the variety of valve involvement types in these patients, the lack of a widely accepted effective anticoagulation approach, and the high surgical mortality rate.