Subclinical left ventricular systolic dysfunction in psoriasis

Psoriasis is a chronic inflammatory skin disease characterized by multiple remissions and relapses, environmental and genetic factors play a role in the pathophysiology of this disease. Previous studies have shown that hypertension, diabetes mellitus, hyperlipidemia, atherosclerosis, myocardial infarction, left ventricular systolic and diastolic dysfunction have increased rate in patients who have psoriasis. Due to the increased risk of cardiovascular morbidity and mortality in individuals who have psoriasis, examination of atherosclerosis and myocardial dysfunction development with non-invasive tests carry significanse to prevent complications that will occur in the future in these patients. In this study, subclinical left ventricular systolic dysfunction was measured by using two-dimensional speckle tracking echocardiography in psoriasis and the relationship of systolic dysfunction possibility were evaluated with the potential severity of illness, duration of illness and pulse wave velocity which is considered a predictor of the susceptibility to atherosclerosis. Eighteen patients with chronic plaque psoriasis, whom have diagnosed atherosclerosis, no conventional risk factors for atherosclerosis and left ventricular ejection fraction of 55% and above, and 18 healthy volunteers who have no psoriasis and other systemic diseases were included into this study. The patients with body mass index over 35, diagnosed atherosclerosis, hypertension, diabetes mellitus, hyperlipidemia and systemic disease except for psoriasis were excluded from this study. The pulse wave velocity measurement, two-dimensional, M-mode, Doppler and tissue Doppler echocardiography were performed in both groups. The left ventricular global longitudinal strain (LTGS), circumferential strain (SGS) and radial strain (RGS) parameters were calculated via two-dimensional speckle tracking echocardiography. Both groups were compared in terms of systolic and diastolic functions by pulse wave velocity and left ventricular two-dimensional, M-mode, Doppler and tissue Doppler, global longitudinal (LTGS), circumferential (SGS) and radial strain (RGS) parameters. In our study, demographic and laboratory data were similar in both groups. A significant difference was observed in the mean values of pulse wave velocity between psoriasis and the control group (mean: 8.2±2.0, and mean: 4.9±1.4, respectively, p <0.0001). No significant difference was observed in the left ventricular end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD), ejection fraction (EF), biplane Simpson's ejection fraction and fractional shortening (FS) values between patients and control group. There was a significant difference in left ventricul longitudinal total global strain (LTGS) mean values between psoriasis and the control group (mean: -17.8±2.8, and mean: -20.1±4.5, respectively, p <0, 01). No significant difference was observed in both circumferential global strain (SGS) values (mean: -16.2±4.8, and mean: -18.2±6.2, respectively, p=0.11) and Radyal Global Strain (RGS) values (mean: 42,4±12,0, and mean: 44,0±18,0; respectively, p=0,7) between patient and control groups. A statistically significant correlation was not found between average LTGS and pulse wave velocity (PWV) in all participants received correlation analysis (p= 0.3, r= 0.17, respectively). No statistically significant correlation was observed between LTGS and psoriasis area severity index (PASI) (p= 0.82, r = -0.055). And also there was no significant correlation between duration of illnes and LTGS (p= 0.57, r=0.142). We have shown that, left ventricular systolic functions decrease independently from arterial stiffness and development of atherosclerosis risk increase, when individuals with psoriasis compared with individuals without this disease even in the absence of conventional risk factors for atherosclerosis in this study. All these results appear to be an outcome of a chronic inflammatory process. Psoriasis does not only cause local skin disorders but also a systemic disease that can affect cardiovascular system. Early diagnosis, treatment and cardiovascular evaluation of these patients will be the right approach. We think that our findings will reflect to clinical outcomes as well as we believe that these data should be supported by prospective studies with a larger patient populations