Makavos George, Ikonomidis Ignatios, Lambadiari Vaia, Koliou Georgia-Angeliki, Pavlidis George, Thymis John, Rafouli-Stergiou Pinelopi, Kostelli Gavriella, Katogiannis Konstantinos, Stamoulis Konstantinos, Kountouri Aikaterini, Korakas Emmanouil, Theodoropoulos Kostas, Frogoudaki Alexandra, Katsimbri Pelagia, Papadavid Evangelia
2nd Department of Cardiology, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece.
2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, Attikon Hospital, Medical School, National and Kapodistrian University of Athens, Rimini 1, Haidari, Athens 12462, Greece.
Eur Heart J Open. 2023 Feb 23;3(2):oead016. doi: 10.1093/ehjopen/oead016. eCollection 2023 Mar.
Psoriasis has been associated with increased cardiovascular (CV) risk. We investigated whether markers of CV function and their change after treatment have a prognostic value for adverse outcomes.
In a prospective study, at baseline and after 6 months of treatment with biological agents, we assessed in 298 psoriasis patients (i) left ventricular global longitudinal strain (GLS) and (ii) carotid-femoral pulse wave velocity (PWV), to evaluate their prognostic value for major adverse cardiovascular events (MACEs), including coronary artery disease, stroke, hospitalization for heart failure, and all-cause death over a 4-year follow-up period. During follow-up, 26 (8.7%) MACEs were recorded. By univariate analysis, decreasing absolute GLS values [hazard ratio (HR): 0.73, < 0.001], decreasing GLS change after treatment (HR: 0.53, = 0.008), and increasing PWV values (HR: 1.16, = 0.049) were associated with adverse outcomes. Baseline GLS and its change post-treatment remained independent predictors of adverse events after adjusting for several confounders ( < 0.05). The addition of baseline GLS and its absolute change post-treatment to SCORE2 increased Harrell's from 0.882 to 0.941. By multivariable analysis, for each 1% increase in absolute baseline GLS values, the risk of MACE decreased by 33% and for each 1% absolute increase of GLS post-treatment compared with the baseline value, the risk of MACE decreased by 58%.
Global longitudinal strain has an independent and additive prognostic value to SCORE2 for adverse CV events in psoriasis, providing timely decision-making for intensive anti-inflammatory treatment and aggressive modification of risk factors to reduce CV risk.
银屑病与心血管（CV）风险增加有关。我们研究了CV功能标志物及其治疗后的变化对不良结局是否具有预后价值。
在一项前瞻性研究中，于基线时以及使用生物制剂治疗6个月后，我们对298例银屑病患者评估了：（i）左心室整体纵向应变（GLS）和（ii）颈股脉搏波速度（PWV），以评估它们对主要不良心血管事件（MACE）的预后价值，这些事件包括冠状动脉疾病、中风、因心力衰竭住院以及在4年随访期内的全因死亡。在随访期间，记录了26例（8.7%）MACE。通过单因素分析，GLS绝对值降低[风险比（HR）：0.73，<0.001]、治疗后GLS变化降低（HR：0.53，=0.008）以及PWV值升高（HR：1.16，=0.049）与不良结局相关。在调整了多个混杂因素后（<0.05），基线GLS及其治疗后的变化仍然是不良事件的独立预测因素。将基线GLS及其治疗后的绝对变化添加到SCORE2中，Harrell's c从0.882提高到0.941。通过多变量分析，基线GLS绝对值每增加1%，MACE风险降低33%，与基线值相比，治疗后GLS绝对值每增加1%，MACE风险降低58%。
整体纵向应变对银屑病患者的不良CV事件具有独立且附加于SCORE2的预后价值，可为强化抗炎治疗和积极改变风险因素以降低CV风险提供及时决策依据。
