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Long-term prognostic value of coronary flow reserve in psoriasis patients
Stefano Piaserico1, Elena Osto2, Giulia Famoso3
1Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy.
Insights
Coronary microvascular dysfunction (CMD) is common in psoriasis patients and predicts poor cardiovascular outcomes. Coronary flow reserve (CFR) effectively identifies patients at high risk for cardiovascular events.
Area of Science:
- Cardiology
- Dermatology
- Vascular Biology
Background:
- Psoriasis significantly increases the risk of premature cardiovascular events and mortality.
- Coronary microvascular function is a critical determinant of cardiovascular health.
- Assessing coronary microvascular function in psoriasis patients without diagnosed cardiovascular disease is crucial for risk stratification.
Purpose of the Study:
- To evaluate the prognostic value of coronary flow reserve (CFR) in asymptomatic psoriasis patients.
- To identify markers of coronary microvascular dysfunction (CMD) in individuals with psoriasis.
Main Methods:
- Retrospective analysis of 153 psoriasis patients without cardiovascular disease.
- Transthoracic Doppler echocardiography used to measure CFR in the left anterior descending coronary artery.
- Coronary microvascular dysfunction (CMD) defined as CFR ≤2.5.
Main Results:
- Coronary microvascular dysfunction (CMD) was identified in 15% of psoriasis patients.
- CMD was significantly associated with severe psoriasis, psoriatic arthritis, hypertension, and longer disease duration.
- Patients with CFR ≤2.5 exhibited significantly lower survival free from cardiovascular events.
Conclusions:
- Coronary flow reserve (CFR) serves as a reliable prognostic marker for cardiovascular event-free survival in psoriasis patients.
- CFR can help identify psoriasis patients at elevated risk for cardiovascular complications.
- Prospective studies are needed to investigate if novel biologic therapies improve CMD and prognosis in these patients.
Background And Aims:
Psoriasis affects more than 3% of the general population and is associated with an increased risk of premature cardiovascular events and death. We assessed the prognostic role of coronary flow reserve (CFR) as a marker of coronary microvascular function in psoriasis patients asymptomatic for cardiovascular disease.
Methods:
We retrospectively analyzed 153 prospectively collected patients affected by psoriasis (123 male; age 36 ± 8 years) without cardiovascular disease. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest, and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. CFR ≤2.5 was the cut off to define the presence of coronary microvascular dysfunction (CMD).
Results:
CMD was present in 23 patients (15%). Multivariable logistic regression analysis showed that CMD was associated with severe psoriasis (OR 3.1, p = 0.03), psoriatic arthritis (OR 2.9, p = 0.03), hypertension (OR 4.1, p = 0.009), and time elapsing since psoriasis diagnosis >6 years (OR 1.9, p = 0.03). Patients with CFR ≤2.5 had a lower survival free from events (p < 0.0001).
Conclusions:
In psoriasis patients, CFR may be a reliable prognostic marker for cardiovascular event-free survival and may help identify patients at higher risk of developing cardiovascular complications. Whether novel biologic therapies able to reduce skin disease will improve CMD and prognosis in these patients needs to be further studied, prospectively.
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