Dermatology Unit, Department of Medicine, University of Padova, Padova, Italy.
University Heart Center, University of Padova, Padova, Italy; Institute of Clinical Chemistry, University of Padova, Padova, Italy.
Atherosclerosis. 2019 Oct;289:57-63. doi: 10.1016/j.atherosclerosis.2019.08.009. Epub 2019 Aug 23.
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.
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).
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).
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.
银屑病影响超过 3%的普通人群，并且与心血管疾病的过早发生和死亡风险增加有关。我们评估了冠状动脉血流储备（CFR）作为冠状动脉微血管功能的标志物在无症状心血管疾病的银屑病患者中的预后作用。
我们回顾性分析了 153 例前瞻性收集的银屑病患者（123 例男性；年龄 36±8 岁），无心血管疾病。通过经胸多普勒超声心动图在静息和腺苷输注期间检测左前降支的 CFR。CFR 是充血期与舒张期血流速度的比值。CFR≤2.5 是定义存在冠状动脉微血管功能障碍（CMD）的截断值。
23 例（15%）存在 CMD。多变量逻辑回归分析表明，CMD 与严重银屑病（OR 3.1，p=0.03）、银屑病关节炎（OR 2.9，p=0.03）、高血压（OR 4.1，p=0.009）和银屑病诊断后时间>6 年（OR 1.9，p=0.03）相关。CFR≤2.5 的患者无事件生存的存活率较低（p<0.0001）。
在银屑病患者中，CFR 可能是心血管事件无事件生存的可靠预后标志物，并可能有助于识别发生心血管并发症风险较高的患者。新型生物疗法能否降低皮肤疾病并改善这些患者的 CMD 和预后，需要进一步前瞻性研究。
