系统性炎症与左心室质量增加之间的关系部分由银屑病中非钙化冠状动脉疾病负担介导。
The relationship between systemic inflammation and increased left ventricular mass is partly mediated by noncalcified coronary artery disease burden in psoriasis.
作者信息
Zhou Wunan, Teklu Meron, Bui Vy, Manyak Grigory A, Kapoor Promita, Dey Amit K, Sorokin Alexander V, Patel Nidhi, Teague Heather L, Playford Martin P, Erb-Alvarez Julie, Rodante Justin A, Keel Andrew, Shanbhag Sujata M, Hsu Li-Yueh, Bluemke David A, Chen Marcus Y, Carlsson Marcus, Mehta Nehal N
机构信息
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States.
Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, United States.
出版信息
Am J Prev Cardiol. 2021 May 30;7:100211. doi: 10.1016/j.ajpc.2021.100211. eCollection 2021 Sep.
OBJECTIVE
Increased left ventricular (LV) mass is an important precursor to heart failure. Inflammation plays an important role in increasing LV mass. However, the contribution of subclinical coronary artery disease (CAD) to the inflammation-LV mass relationship is unknown. In subjects with psoriasis, a chronic inflammatory skin disease, we evaluated if systemic inflammation assessed by plasma glycoprotein A (GlycA) associated with LV mass measured on coronary CT angiography (CCTA). Additionally, we analyzed whether this relationship was mediated by early CAD assessed as noncalcified coronary burden (NCB).
METHODS
We performed an of subjects with psoriasis free of known cardiovascular disease, 189 of whom were followed over one year. All participants had GlycA measurements by nuclear magnetic resonance spectroscopy and LV mass and NCB quantified by CCTA.
RESULTS
The cohort had a mean age of 50.3 (±12.9) years and 59% were male. There was moderate psoriasis severity and low cardiovascular risk. LV mass increased by GlycA tertiles [1st tertile:24.6 g/m(3.8), 2nd tertile:25.5 g/m(3.8), 3rd tertile:27.7 g/m(5.5), <0.001]. Both GlycA (β=0.24, = 0.001) and NCB (β=0.50, <0.001) associated with LV mass in models adjusted for age, sex, hypertension, hypertension therapy, lipid therapy, biologic therapy for psoriasis, waist:hip ratio, psoriasis disease duration and severity. In multivariable-adjusted mediation analyses, NCB accounted for 32% of the GlycA-LV mass relationship. Finally, over one year, change in NCB independently associated with change in LV mass (β=0.25, = 0.002).
CONCLUSIONS
Both systemic inflammation and coronary artery NCB were associated with LV mass beyond cardiovascular risk factors in psoriasis. Furthermore, a substantial proportion of the inflammatory-LV mass relationship was mediated by NCB. These findings underscore the possible contribution of early coronary artery disease to the relationship between systemic inflammation and LV mass.
目的
左心室（LV）质量增加是心力衰竭的重要先兆。炎症在增加LV质量方面起重要作用。然而，亚临床冠状动脉疾病（CAD）对炎症与LV质量关系的影响尚不清楚。在患有慢性炎症性皮肤病银屑病的受试者中，我们评估了通过血浆糖蛋白A（GlycA）评估的全身炎症是否与冠状动脉CT血管造影（CCTA）测量的LV质量相关。此外，我们分析了这种关系是否由评估为非钙化冠状动脉负荷（NCB）的早期CAD介导。
方法
我们对无已知心血管疾病的银屑病患者进行了一项研究，其中189人随访了一年。所有参与者均通过核磁共振波谱法测量GlycA，并通过CCTA对LV质量和NCB进行量化。
结果
该队列的平均年龄为50.3（±12.9）岁，59%为男性。银屑病严重程度中等，心血管风险较低。LV质量随GlycA三分位数增加[第一三分位数：24.6g/m（3.8），第二三分位数：25.5g/m（3.8），第三三分位数：27.7g/m（5.5），P<0.001]。在根据年龄、性别、高血压、高血压治疗、脂质治疗、银屑病生物治疗、腰臀比、银屑病病程和严重程度进行调整的模型中，GlycA（β=0.24，P = 0.001）和NCB（β=0.50，P<0.001）均与LV质量相关。在多变量调整的中介分析中，NCB占GlycA与LV质量关系的32%。最后，在一年时间里，NCB的变化与LV质量的变化独立相关（β=0.25，P = 0.002）。
结论
在银屑病患者中，全身炎症和冠状动脉NCB均与LV质量相关，且不受心血管危险因素的影响。此外，炎症与LV质量关系中的很大一部分由NCB介导。这些发现强调了早期冠状动脉疾病对全身炎症与LV质量关系的可能影响。
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