title: Impaired coronary flow reserve in young patients affected by severe psoriasis.
abstract: 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 abnormalities.
  
  
  METHODS
  56 young patients (pts) with Pso (42 M, aged 37±3 years) without clinical evidence of cardiovascular 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).
  
  
  CONCLUSIONS
  CFR in young pts with severe Pso without coronary disease is reduced suggesting a coronary 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 systemic inflammation and might explain the increased cardiovascular risk conferred by Pso.
authors.affiliation: Division of Cardiology, Department of Cardiologic, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Osto
authors.forename: Stefano
authors.initials: S
authors.lastname: Piaserico
authors.forename: Anna
authors.initials: A
authors.lastname: Maddalozzo
authors.forename: Giulia
authors.initials: G
authors.lastname: Forchetti
authors.forename: Roberta
authors.initials: R
authors.lastname: Montisci
authors.forename: Giulia
authors.initials: G
authors.lastname: Famoso
authors.forename: Andrea
authors.initials: A
authors.lastname: Giovagnoni
authors.forename: Andrea
authors.initials: A
authors.lastname: Peserico
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.forename: Francesco
authors.initials: F
authors.lastname: Tona
mesh_terms: D000241:Adenosine; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001783:Blood Flow Velocity; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D018618:Echocardiography, Doppler, Color; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D007558:Italy; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008833:Microcirculation; D015999:Multivariate Analysis; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011565:Psoriasis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014665:Vasodilator Agents
chemical_list: D000893:Anti-Inflammatory Agents; D014665:Vasodilator Agents; D000241:Adenosine