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

Leon Iri Kupferwasser, MD^*, Gerd Hafner, MD, Susanne Mohr-Kahaly, MD^*, Raimund Erbel, MD, FACC, J.ürgen Meyer, MD, FACC^* and Harald Darius, MD, FACC^*

^* II. Medical Clinic, Mainz University, Mainz, Germany
Institute of Clinical Chemistry, Mainz University, Mainz, Germany
Division of Cardiology, Essen University, Essen, Germany

View larger version (17K): [in a new window]   Figure 1 Frequency of embolic events in four different groups of patients according to vegetation size and presence of APA (*p < 0.05).

View larger version (12K): [in a new window]   Figure 2 Mean F1+2 levels and standard deviations in patients with embolic events and control subjects. (Upper range of normal values = 1.1 nM/l; nM/l = nmol per liter.)

View larger version (13K): [in a new window]   Figure 3 PAI-1 levels in 26 patients with embolic events according to normal and elevated anticardiolipin-antibody titers. A majority of values in both patient groups exceed the normal range of PAI-1. However, 2/18 (11%) and 6/8 (75%) of patients with normal and elevated ACA titers have PAI-1 levels >15 UIU/ml, respectively. (Upper range of normal values = 3.5 UIU/ml; the horizontal bars indicate the mean values in each patient group; UIU = urokinase inhibiting units.)

View larger version (13K): [in a new window]   Figure 4 The vWF levels in 26 patients with embolic events according to normal and elevated anticardiolipin-antibody titers. A majority of values in both patient groups exceed the normal range of vWF. This is not surprising as vWF is an acute-phase reactant. Nevertheless, 1/18 (6%) and 4/8 (50%) of patients with normal and elevated ACA titers have vWF levels >200%, respectively. (Upper range of normal values = 150%.)

View larger version (13K): [in a new window]   Figure 5 Mean aPC levels and standard deviations in patients with embolic events and control subjects. (Upper range of normal values = 70%.)