Impaired coronary flow reserve in young patients affected by severe psoriasis

Objective: Our study aimed to evaluate the effects of psoriasis (Pso) on coronary microvascular function and whether there is a relationship between disease activity scores and coronary blood flow abnormali- ties. Methods: 56 young patients (pts) with Pso (42 M, aged 37 ± 3 years) without clinical evidence of car- diovascular diseases, and 56 controls matched for age and gender were studied. Coronary flow velocity in the left anterior descending coronary artery was detected by transthoracic echocardiography at rest and during adenosine infusion. Coronary flow reserve (CFR) was the ratio of hyperaemic diastolic flow velocity (DFV) to resting DFV. A CFR ≤ 2.5 was considered abnormal. Results: In pts with Pso, CFR was lower than in controls (3.2 ± 0.9 vs. 3.7 ± 0.7, p = 0.02). CFR was abnormal (≤2.5) in 12 pts (22% vs. 0% controls, p < 0.0001). Moreover, in pts with CFR ≤ 2.5, Psoriasis Area Severity Index (PASI), a clinical score for Pso severity, was higher (11 ± 6 vs. 7 ± 3, p = 0.006) compared to pts with CFR > 2.5. At multivariable analysis PASI remained the only determinant of CFR ≤ 2.5 (p = 0.02). Conclusion: CFR in young pts with severe Pso without coronary disease is reduced suggesting a coro- nary microvascular dysfunction, independently related to the severity and extension of Pso. This early microvascular impairment might be hypothesized as the consequence of prolonged and sustained sys- temic inflammation and might explain the increased cardiovascular risk conferred by Pso.