Anticardiolipin antibodies and left atrial thrombus as indicators for increased risk of thromboembolic events in patients with isolated mitral stenosis

الملخص EN

Background: Rheumatic mitral stenosis (MS) carries a constant risk of systemic embolization, especially in neglected patients.

Anticardiolipin antibodies(ACLs) are strongly associated with venous and arterial thrombosis.

However the role of ACLs in the formation of left atrial (LA) thrombus has not been studied.

Objectives: To determine the incidence of ACLs in patients with MS and also to evaluate, for the first time, the role of ACLs in the formation of LA thrombus detected by transesophageal echocardiography (TEE) and their significance regarding the development of thromboembolic events in patients with MS.

Patients and Methods: The study population consisted of 113 non-anticoagulatedpatients with MS and 20 healthy control subjects.

Serum levels of IgG and IgMACLs were determined in all patients and control subjects.

Transthoracic echocardiographic (TTE) and TEE studies were performed in all patients to measure cardiac chambers; mitral valve area(MVA);and left ventricular ejection fraction (EF %); and to examine LA appendage (LAa) and LA for the presence of thrombi.

Results: ACLs either IgG or IgM was +ve in 29% (33/113) of patients vs 5%(l/20) of control subjects, p<0.001.

LAa and or LA thrombi were detected by TEE 12% (14/113) of all patients.

LAa and or LA thrombi were detected in 33%(l'l/33) of +ve ACLs vs 3.8%(3/80) -ve ACLs patients, p<0.001.

Previous embolization was documented in 7.9%(9/I13; 7 had +ve ACLs vs 2 had -ve ACLs) of all patients and 77%(7/9) of them had LAa and/or LA thrombus.

On the other hand, atrial fibrillation (AF); LA diameter; MVA; and EF % were insignificantly different between either +ve and -ve (ACLs) or patients with and without LA thrombi.

Conclusion: Anticardiolipin antibodies either IgG or IgM is commonly detected in patients with MS.

There is a significant association between +ve ACLs and LA thrombi detected by TEE.

So these antibodies could be considered as a warning laboratory tool for thrombus formation and seem to be considered an independent risk factor for thromboembolic events in patients with mitral stenosis.