Impaired longitudinal myocardial deformation, coronary microcirculatory dysfunction and increased intima-media thickness predict adverse cardiovascular events in psoriatic patients:a 4 year follow-up

Abstract

Abstract Introduction Psoriasis has been associated with vascular and myocardial dysfunction, atherosclerosis and increased cardiovascular risk in the setting of inflammation and oxidative stress. We aimed to evaluate the prognostic value of markers of myocardial deformation, coronary microcirculatory function and systemic inflammation and oxidative stress for future cardiovascular events. Methods In 260 psoriasis patients We measured a)left ventricular global longitudinal strain (GLS) by speckle tracking, b) coronary flow reserve (CFR), of the left anterior descending artery by pulse wave echocardiography, c) carotid-femoral pulse wave velocity (PWV), d) carotid intima media thickness (IMT) and e) inflammatory and markers of oxidative stress, namely interleukin-6,-12,-17,TNF-α,fetuin-α and protein carbonyl. Bivariate correlations of these measures with incidence of major cardiovascular events (MACE) defined as acute coronary syndrome, stroke and hospitalization for heart failure were performed. Results During a mean 4 year follow-up period (48±11monts) 21 MACEs occurred. By Cox regression analysis Incidence of MACEs were associated with impaired GLS (b=1.05 p=0,01, mean GLS −17.3±4), impaired CFR (b=−0.75, p=0.04, mean CFR 2.68±0.9) fetuin levels (b=0.70. r=0.046, mean fetuin value 45±24ng/ml) and IMT (b=0.79, P=0.015, mean IMT=1.3±0.6cm) after adjusting for age, sex and atheroclerotic risk factors. Among the aforementioned markers, GLS had the strongest value for prediction of MACEs (area under the curve 0.82 p=0.017). A cut-off value of GLS >−16.5% predicted MACEs with a sensitivity 80% and specificity of 82.6%. Conclusion Impaired myocardial and vascular function is associated with adverse cardiovascular events in psoriasis. GLS as a marker of subclinical myocardial dysfunction has the strongest predictive value for MACEs incidence during a 4-year follow-up study. Funding Acknowledgement Type of funding source: None