Impaired left ventricular apical rotation is associated with disease activity of psoriatic arthritis

Although early cardiovascular (CV) involvement has been found in patients with psoriatic arthritis (PsA), few studies have related this to PsA disease activity. The aim of our study was to evaluate left ventricular (LV) mechanics using novel, more sensitive techniques based on assessment of LV rotation for the detection of impaired LV function in patients with PsA correlated with disease-related risk factors.

Seventy-six patients with PsA and 24 healthy control subjects were enrolled, including 33 patients without any CV risk factors. All participants underwent conventional echocardiography and 2-dimensional speckle tracking imaging. Global longitudinal, apical circumferential, and radial strain, and apical rotation and maximal untwisting rate during early diastole were measured.

Although patients with PsA had normal LV ejection fraction, the myocardial deformation in multidimensional planes was impaired. Based on the cutoff point derived from the apical rotation of control subjects, 81% of the patients had subclinical systolic and/or diastolic dysfunction. Similar prevalence was found in patients without CV risk factors. Spearman correlation demonstrated a relationship between Disease Activity Score in 28 joints (r=0.299, p=0.011), erythrocyte sedimentation rate (r=0.309, p=0.008), and impaired apical rotation, even after adjusting for age and hypertension. No correlation was found between longitudinal, radial, and circumferential strain and disease activity.

Subclinical impaired myocardial deformation was common in patients with PsA even without CV risk factors. Apical rotation was associated with the status of PsA disease activity. These new speckle tracking echocardiography techniques can detect subclinical myocardial involvement in PsA.