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• Clinical Article •
Multiparametric cardiac magnetic resonance assessment of functional and tissue characterization in antiphospholipid syndrome
XU Ke  HE Jian  LIU Wangyan  SUN Xiaoxuan  WANG Qiang  ZHU Xiaomei  XU Yi 

DOI:10.12015/issn.1674-8034.2026.02.012.


[Abstract] Objective To evaluate myocardial involvement in patients with antiphospholipid syndrome (APS) using multiparametric cardiac magnetic resonance (CMR), compare differences between primary APS (PAPS) and secondary APS (SAPS), and explore their implications for early detection and risk stratification.Materials and Methods This retrospective study enrolled 30 APS patients and 30 age- and sex-matched controls who underwent CMR between January 2022 and June 2025. CMR assessment encompassed biventricular structural and functional parameters, native T1 and T2 values, extracellular volume (ECV), and late gadolinium enhancement (LGE) metrics. Subgroup analysis was performed by etiology-PAPS versus SAPS. Using LGE burden (LGE%) as a continuous variable, evaluate its correlation with laboratory indicators, cardiac functional and mapping measures.Results Compared with the control group, APS patients showed lower biventricular ejection fractions (EF) and significantly increased left ventricular end systolic volume index (LVESVI), native T1, T2 values, ECV, and LGE% (all P < 0.05). In subgroup analysis, the SAPS group showed higher right ventricular end diastolic volume index (RVEDVI) [(78.92 ± 15.05) mL/m2 vs. (59.94 ± 6.01) mL/m2], right ventricular stroke volume index (RVSVI) [(36.95 ± 10.03) mL/m2 vs. (26.50 ± 4.50) mL/m2], right ventricular cardiac index (RVCI) [2.85 (2.26, 3.14) L/(min∙m2) vs. 1.93(1.54, 2.11) L/(min∙m2)], native T1 [1 294.00 (1 264.75, 1 327.00) ms vs. 1 245.00 (1 225.50, 1 297.00) ms], and ECV (32.55% ± 4.45% vs. 27.94% ± 1.86%) than the PAPS group (all P < 0.05). Correlation analysis showed that LGE% was moderately to strongly correlated with logNT-proBNP, LVEF (inverse), LVEDVI, LVESVI, and left ventricular mass index (LVMI) (|r| = 0.411 to 0.579, all P < 0.05), but not with mapping parameters.Conclusions Multiparametric CMR can characterize myocardial involvement in APS from both functional and tissue perspectives and differentiate the phenotypic features between PAPS and SAPS. LGE burden reflects myocardial scarring and functional impairment, whereas mapping parameters are more sensitive to diffuse interstitial injury. The combination of these parameters may facilitate risk stratification and follow-up monitoring in APS.
[Keywords] antiphospholipid syndrome；cardiac magnetic resonance；magnetic resonance imaging；myocardial fibrosis；late gadolinium enhancement

XU Ke1   HE Jian1   LIU Wangyan1   SUN Xiaoxuan2   WANG Qiang2   ZHU Xiaomei1   XU Yi1*  

1 Department of Radiology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China

2 Department of Rheumatology and Immunology, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China

Corresponding author: XU Y, E-mail: yixu@njmu.edu.cn

Conflicts of interest   None.

Received  2025-11-16
Accepted  2026-01-26
DOI: 10.12015/issn.1674-8034.2026.02.012
DOI:10.12015/issn.1674-8034.2026.02.012.

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