Division of Cardiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
Atherosclerosis. 2012 Mar;221(1):113-7. doi: 10.1016/j.atherosclerosis.2011.12.015. Epub 2011 Dec 22.
Our study aimed to evaluate the effects of psoriasis (Pso) on coronary microvascular function and whether there is a relationship between disease activity scores and coronary blood flow abnormalities.
56 young patients (pts) with Pso (42 M, aged 37±3 years) without clinical evidence of cardiovascular diseases, and 56 controls matched for age and gender were studied. Coronary flow velocity in the left anterior descending coronary artery was detected by transthoracic echocardiography at rest and during adenosine infusion. Coronary flow reserve (CFR) was the ratio of hyperaemic diastolic flow velocity (DFV) to resting DFV. A CFR≤2.5 was considered abnormal.
In pts with Pso, 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 (22% vs. 0% controls, p<0.0001). Moreover, in pts with CFR≤2.5, Psoriasis Area Severity Index (PASI), a clinical score for Pso severity, was higher (11±6 vs. 7±3, p=0.006) compared to pts with CFR>2.5. At multivariable analysis PASI remained the only determinant of CFR≤2.5 (p=0.02).
CFR in young pts with severe Pso without coronary disease is reduced suggesting a coronary microvascular dysfunction, independently related to the severity and extension of Pso. This early microvascular impairment might be hypothesized as the consequence of prolonged and sustained systemic inflammation and might explain the increased cardiovascular risk conferred by Pso.
本研究旨在评估银屑病（Pso）对冠状动脉微血管功能的影响，以及疾病活动评分与冠状动脉血流异常之间是否存在关联。
研究纳入了 56 例无心血管疾病临床证据的年轻 Pso 患者（42 例男性，年龄 37±3 岁）和 56 例年龄和性别匹配的对照组。采用经胸超声心动图在静息和腺苷输注时检测左前降支冠状动脉的血流速度。冠状动脉血流储备（CFR）为充血性舒张期血流速度（DFV）与静息 DFV 的比值。CFR≤2.5 被认为异常。
在 Pso 患者中，CFR 低于对照组（3.2±0.9 比 3.7±0.7，p=0.02）。12 例患者（22%）的 CFR 异常（≤2.5），而对照组为 0%（p<0.0001）。此外，在 CFR≤2.5 的患者中，银屑病面积严重程度指数（PASI），一种用于评估 Pso 严重程度的临床评分，更高（11±6 比 7±3，p=0.006）。多变量分析显示，PASI 是 CFR≤2.5 的唯一决定因素（p=0.02）。
在无冠状动脉疾病的严重 Pso 年轻患者中，CFR 降低提示存在冠状动脉微血管功能障碍，与 Pso 的严重程度和范围独立相关。这种早期微血管损伤可能是由于长期和持续的系统性炎症引起的，并且可能解释了 Pso 带来的心血管风险增加。
