Antiphospholipid syndrome (APS) is an autoimmune disorder characterized
by arterial, venous, and/or small vessel thrombosis, pregnancy
morbidity, and persistently elevated levels of antiphospholipid
antibodies (aPL). Cardiovascular disease (CVD) in APS can present as
heart valvular disease (HVD), macro-micro-coronary artery disease (CAD),
myocardial dysfunction, cardiac thrombi, or pulmonary hypertension.
Brain disease presents as stroke or transient ischemic attack (TIA) and
less frequently as cerebral venous thrombosis, seizures, cognitive
dysfunction, multiple sclerosis (MS)-like syndrome, or chorea. Infarcts
and focal white matter hyperenhancement are the commonest brain (MRI)
abnormalities, while myocardial ischemia/fibrosis, valvular
stenosis/regurgitation, or cardiac thrombi are the main abnormalities
detected by cardiovascular magnetic resonance. This review aims to
present the existing evidence on brain/heart involvement and their
interrelationship in APS and the role of brain/heart MRI in their
evaluation. Embolic brain disease, due to HVD, CAD, and/or cardiac
thrombus, or brain hypo-perfusion, due to myocardial dysfunction, are
among the main brain/heart interactions in APS and they are considered
determinants of morbidity and mortality. Currently, there is no evidence
to support the use of combined brain/heart MRI in asymptomatic APS
patients. Until more data will be available, this approach may be
considered in APS patients at high risk for CVD/stroke, such as systemic
lupus erythematosus with high-risk aPL profile or high scores in CVD
risk prediction models; APS patients with HVD/thrombus, CAD, or heart
failure; those with classic and non-criteria neurologic APS
manifestations (seizures, cognitive dysfunction, MS-like syndrome); or
with aggressive multi-organ disease.
(EN)
/aggregator-openarchives/portal/institutions/uoa
