2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece.
2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece.
J Hum Hypertens. 2022 Dec;36(12):1113-1120. doi: 10.1038/s41371-021-00640-2. Epub 2021 Nov 25.
Psoriatic disease is associated with vascular and myocardial dysfunction. We aimed to evaluate endothelial glycocalyx barrier properties and microvascular perfusion in psoriatic patients, as well as their correlation with carotid intima-media thickness (cIMT) and markers of left ventricular (LV) myocardial deformation. We examined 297 psoriatic patients and 150 controls, adjusted for age, sex, and atherosclerotic risk factors. The severity of psoriatic disease was estimated using the psoriasis area and severity index (PASI). Perfused boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter 5-25 μm using Sidestream Dark Field camera (Microscan, GlycoCheck). Increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion, including red blood cells filling (RBCF) and functional microvascular density, were also calculated. We measured cIMT, coronary flow reserve (CFR) and markers of myocardial deformation by speckle-tracking imaging, namely global longitudinal strain (GLS) and percentage changes between peak twisting and untwisting at mitral valve opening (%dpTw-Utw). Compared to controls, psoriatic patients had higher PBR (2.13 ± 0.29μm versus 1.78 ± 0.25μm, p < 0.001) and lower RBCF and functional microvascular density (p < 0.001). Increased PASI was associated with elevated PBR and more impaired cIMT and GLS (p < 0.05). There was an inverse association of PBR with RBCF and functional microvascular density (p < 0.001). In psoriatic population, increased PBR was related to increased cIMT, reduced CFR, impaired GLS and decreased %dpTw-Utw (p < 0.001). Glycocalyx thickness is reduced in psoriatic patients, which in turn impairs microvascular perfusion, and is associated with carotid IMT and impaired coronary and myocardial function.Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT02144857.
银屑病与血管和心肌功能障碍有关。我们旨在评估银屑病患者的内皮糖萼屏障特性和微血管灌注，并研究其与颈动脉内膜中层厚度（cIMT）和左心室（LV）心肌变形标志物的相关性。我们检查了 297 名银屑病患者和 150 名对照者，调整了年龄、性别和动脉粥样硬化危险因素。使用银屑病面积和严重程度指数（PASI）评估银屑病的严重程度。使用 Sidestream Dark Field 相机（Microscan，GlycoCheck）在直径为 5-25μm 的舌下微血管中无创性测量灌注边界区域（PBR），这是糖萼屏障功能的标志物。PBR 增加表明糖萼厚度降低。还计算了微血管灌注指数，包括红细胞填充（RBCF）和功能性微血管密度。我们通过斑点追踪成像测量 cIMT、冠状动脉血流储备（CFR）和心肌变形标志物，即整体纵向应变（GLS）和二尖瓣开口时扭转和未扭转峰值之间的百分比变化（%dpTw-Utw）。与对照组相比，银屑病患者的 PBR 更高（2.13±0.29μm 比 1.78±0.25μm，p<0.001），RBCF 和功能性微血管密度更低（p<0.001）。PASI 增加与 PBR 升高以及更严重的 cIMT 和 GLS 降低有关（p<0.05）。PBR 与 RBCF 和功能性微血管密度呈负相关（p<0.001）。在银屑病患者中，PBR 增加与 cIMT 增加、CFR 降低、GLS 受损和 %dpTw-Utw 减少有关（p<0.001）。银屑病患者的糖萼厚度降低，进而损害微血管灌注，并与颈动脉 IMT 以及冠状动脉和心肌功能受损相关。临床试验注册-URL：http://www.clinicaltrials.gov。唯一标识符：NCT02144857。
