Close association between valvular heart disease and central nervous system manifestations in antiphospholipid syndrome

Objectives

Heart valve lesions and central nervous system (CNS) involvement are among the most common manifestations of antiphospholipid syndrome (APS). We evaluated possible inter-relations between these manifestations in a large group of APS patients.

Methods

Two hundred and eighty-four APS patients were retrospectively evaluated, 159 of whom had primary APS (PAPS). Cardiac–CNS associations were determined for the entire study population, and for subgroups of patients with PAPS or APS secondary to systemic lupus erythematosus (SLE).

Results

Significant associations where found between cardiac vegetations and epilepsy (P < 0.02), and between cardiac valves thickening or dysfunction and migraine (P = 0.002). Borderline association was found between valvular vegetations and migraine (P = 0.09). Subanalyses revealed that patients with PAPS had significant associations between cardiac valve pathology and both epilepsy and migraine, while patients with APS secondary to SLE presented no such associations.

Conclusions

Our study points to potentially different biological behaviors in PAPS than in APS secondary to SLE. According to our results, the presence of cardiac valves pathology may be a risk factor for several CNS involvements in PAPS.