Abstract 19345: Psoriasis Early Affects Coronary Flow Reserve: New Insights Into Coronary Microvascular Dysfunction and Inflammation.
Background:Psoriasis (Ps) is a recently recognized independent determinant for myocardial infarction (MI), associated with cardiovascular risk factors.We investigated whether coronary flow reserve (CFR), an index of coronary microvascular function, was impaired in young patients with Ps and the relationship between clinical markers of Ps activity and coronary blood flow abnormalities.
Methods: 56 patients (pts) with Ps (42 M, aged 37±7 years) without clinical evidence of heart diseases, and 48 controls matched for age and sex were studied. Coronary flow velocity in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography at rest and during adenosine infusion. CFR was the ratio of hyperaemic diastolic flow velocity (DFV) to resting DFV. A CFR ≤2.5 was considered abnormal. Mean time from diagnosis of Ps was 17±7 years.
Results: In pts with Ps, CFR was lower than in controls (3.2±0.9 vs 3.7±0.7, p=0.02). CFR was abnormal (≤2.5) in 12 pts with Ps (22% vs 0% controls, OR 1.27, p<0.0001). Moreover, in CFR ≤2.5 pts Psoriasis Area Severity Index (PASI), a clinical grade of Ps severity, was higher (11±6 vs 7±3, p=0.006) and duration of the disease was longer (13±6 vs 9±5 years, p=0.03). The highest probability for patients with psoriasis to have a CFR <2.5 occurred in those patients with higher PASI (p=0.03) At multivariable analysis adjusted for age, smoke, hypertension and gender, PASI was the only determinant of CFR ≤2.5 (Figure).
Conclusions: CFR is often reduced in pts with Ps, suggesting a preclinical coronary microvascular impairment. This microvascular dysfunction seems to be related to the severity, extension and duration of Ps. Our findings may explain the increased risk of MI conferred by Ps.
- © 2010 by American Heart Association, Inc.