Relation between left ventricular and/or left atrial thrombus and anticardiolipin antibodies in patients with acute myocardial infarction

Abstract

Anticardiolipin (aCL) antibodies are immunglobulins of class immunoglobulin G (IgG) and immunoglobulin (IgM), which have recently been shown to be associated with recurrent episodes of thrombosis, spontaneous abortion, and thrombocytopenia, particularly in patients affected by autoimmune diseases. 1‐3 The antiphospholipid antibodies can be observed in a number of other pathologic conditions, and even in the absence of any underlying disease. Hamsten et al4 observed an increased prevalence of patients with elevated aCL antibody levels in young patients with acute myocardial infarction (AMI). Furthermore, high titers of these antibodies appeared to serve as a marker of high risk for recurrent cardiovascular events. In accordance with this, Klemp et al5 reported an association between elevated levels of aCL antibodies and coronary artery disease (CAD). After these reports, there have been many studies on myocardial infarction or CAD in which the frequency of elevated aCL antibodies was not appreciably higher in patients than in control subjects, and such antibodies were not predictive for subsequent cardiovascular complications. 1 Thus, the importance of serum aCL levels in the natural history and prognosis of CAD is still undetermined. Antiphospholipid antibodies have been identified as a potential risk factor for arterial and venous thromboembolic events. Gorelick et al6 described a lupus patient with extensive cardiac thrombus formation. Zuckerman et al7 reported that during the follow-up period the rate of thromboembolic events and myocardial reinfarction in patients with AMI was significantly higher in the aCL-positive patients than in the aCL-negative group. They suggested that the presence of aCL is a marker for increased risk of myocardial reinfarction and thromboembolic events after AMI. This study was undertaken to determine the relation between anticardiolipin antibodies and left atrial (LA) and/or left ventricular (LV) thrombus detected by transthoracic and/or transesophageal echocardiography (TEE) in patients with AMI. ••• The study group consisted of 77 consecutive subjects with a first AMI who underwent transesophageal echocardiography and TEE. Inclusion criteria for the study were a history of typical chest pain, ST-segment elevation in 2 contiguous leads, and a transient increase in creatine kinase exceeding twice the upper limit of normal. Exclusion criteria were primary myocardial or valvular heart disease and atrial fibrillation. Also, patients with acute or chronic infection, autoimmune or chronic inflammatory disorders, as well as patients with malignancy were excluded (total 5). During the recruitment period, 4 patients were excluded because of poor echocardiographic image quality. All patients gave written informed consent, and the study was approved by the Science and Ethics