Cited by 105Infective Endocarditis Diagnosis and ManagementSystemic Lupus Erythematosus ResearchStreptococcal Infections and Treatments

The presence of infection-related antiphospholipid antibodies in infective endocarditis determines a major risk factor for embolic events

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Kupferwasser, Leon Iri, Hafner, Gerd, Mohr-Kahaly, Susanne, Erbel, Raimund, Meyer, Jürgen, Darius, Harald·1999·Journal of the American College of Cardiology

Abstract

Objectives The impact of infection-associated antiphospholipid antibodies (APA) on endothelial cell activation, blood coagulation and fibrinolysis was evaluated in patients with infective endocarditis with and without major embolic events.Background An embolic event is a common and severe complication of infective endocarditis. Despite the fact that APAs are known to be associated with infectious diseases, their pathogenic role in infective endocarditis has not been clearly defined.Methods The relationship among the occurrence of major embolic events, echocardiographic vegetation size, endothelial cell activation, thrombin generation, fibrinolysis and APA was examined in 91 patients with definite infective endocarditis, including 26 patients with embolic events and 65 control subjects without embolic events.Results Overall, 14.3% of patients exhibited elevated APA levels. Embolic events occurred more frequently in patients with elevated levels of APA than in patients without (61.5% vs. 23.1%; p = 0.008). Patients with elevated levels of APA showed higher levels of prothrombin-fragment F1 +2 (p = 0.005), plasminogen-activator inhibitor 1 (p = 0.0002), von Willebrand factor (p = 0.002) and lower levels of activated protein C (p = 0.001) than patients with normal levels of APA. Thrombin generation and endothelial cell activation were both positively correlated with levels of APA. The occurrence of elevated APA levels was frequently associated with structural valve abnormalities (p = 0.01) and vegetations >1.3 cm (p = 0.002).Conclusions Infection-associated elevated APA levels in patients with infective endocarditis are related to endothelial cell activation, thrombin generation and impairment of fibrinolysis. This may contribute to the increased risk for major embolic events in these patients.

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  1. [34]34. Schleef RR, Bevilacqua MP, Sawdey M, et al. Cytokine activation of vascular endothelium. J Biol Chem 1988;263: 5797-5803.
  2. [39]39. Matsuura E, Igarashi Y, Fujimoto M, et al. Anticardiolipin cofactors and differential diagnosis of autoimmune disease [letter]. Lancet 1990;336:177-8.
  3. [47]47. Lins M, Zurborn KH, Pries B, Bruhn HD. The thrombotic status of patients with inflammatory diseases. Dtsch Med Wochenschr 1996;121:855-9.

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Authors
Kupferwasser, L. I., Hafner, G., Mohr-Kahaly, S., Erbel, R., Meyer, J., & Darius, H.
Affiliations
  • Johannes Gutenberg University Mainz (DE)
  • Essen University Hospital (DE)
Corresponding author
Kupferwasser, Leon Iri
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
1999-04
Volume
33
Issue
5
Pages
1365-1371
ISSN
0735-1097 (ISSN-L)
OpenAlex
W2065361267
Cited by
105
References
57
Citations by year
2025: 4 · 2024: 1 · 2023: 3 · 2020: 1 · 2019: 5 · 2018: 4 · 2017: 3 · 2016: 4 · 2015: 7 · 2014: 5 · 2013: 4 · 2012: 4
FWCI
4.11
Type
journal article
Language
en
Open access
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Funders
Deutsche Forschungsgemeinschaft
Topics
  • Health Sciences › Medicine › Epidemiology › Infective Endocarditis Diagnosis and Management
  • Health Sciences › Medicine › Rheumatology › Systemic Lupus Erythematosus Research
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
Keywords
antiphospholipid antibodies, infective endocarditis, embolic events, endothelial activation, thrombin generation, fibrinolysis, prothrombin fragment 1+2, plasminogen activator inhibitor-1, von Willebrand factor, activated protein C, coagulation
MeSH terms
Adult, Aged, Cerebral Angiography, Intracranial Embolism and Thrombosis, Endocarditis, Bacterial, Enzyme-Linked Immunosorbent Assay, Female, Fibrinolysis, Follow-Up Studies, Heart Valves, Humans, Male, Middle Aged, Prognosis, Protein C, Retrospective Studies, Risk Factors, Thrombin, Tomography, X-Ray Computed, Biomarkers, Antibodies, Antiphospholipid, Plasminogen Activator Inhibitor 1, Echocardiography, Transesophageal, Ultrasonography, Doppler

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