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AB0738 Preclinical impairment of myocardial function and endothelial vascular markers in early psoriatic arthritis: association with vitamin d levels and inflammation
  1. A Lo Gullo1,
  2. G Mandraffino2,
  3. CO Aragona2,
  4. V Cairo2,
  5. A Saitta1
  1. 1Clinical and Experimental Medicine
  2. 2Policlinico G Martino, Messina, Italy

Abstract

Background Patients with psoriatic arthritis (PsA) have an increased prevalence of cardiovascular risk factors such as hypertension, myocardial dysfunction, and type 2 diabetes mellitus, and cardiovascular diseases (CVD) are the leading cause of death in these patients.

Furthermore, PsA patients have a high prevalence of vitamin D (vit-D) deficiency, considered an independent predictor of cardiovascular diseases and all-cause mortality in several clinical settings.

Objectives We aimed to evaluate left ventricular (LV) mechanics in patients diagnosed with PsA and no clinical evidence for cardiovascular disease (CVD) using a more sensitive technique, which evaluates myocardial deformation in multidimensional planes for the detection of impaired LV function. Furthermore we evaluated carotid intima media thickness (cIMT) and pulse wave velocity (PWV), circulating proangiogenic haematopoietic cells (PHCs),as markers of endothelial dysfunction. We investigated the association between vitamin D levels, inflammatory mediators, markers of endothelial and myocardial dysfunction in patients with PsA.

Methods The study enrolled 19 PsA patients and 16 sex- -age matched healthy controls. All participants underwent conventional echocardiography and 2-dimensional speckle tracking echocardiography (STE). Global longitudinal, circumferential, and radial strain were measured. PHCs,Vitamin D levels, C-reactive protein (CRP), fibrinogen, (PWV), (cIMT) were also evaluated.

Results PHCs count and vitamin D levels were lower in PsA patients as compared to controls, while fibrinogen, CRP, PWV and cIMT were higher in PsA patients. STE analysis showed that PsA patients had significantly lower global longitudinal strain (-16.11±2.89% and -19.15±1.9%, respectively, p=0.05) and global circumferential strain (-14.21±2.7% and -20.22±4.13%, respectively, p<0.01) versus control group.

No correlation was found between longitudinal and circumferential strains and disease-related risk factors.

Vitamin D levels was found to correlate with longitudinal strain, ejection fraction, PHCs, diseases activity markers, and fibrinogen levels.

Conclusions Subclinical impaired myocardial deformation and endothelial dysfunction were common in patients with PsA even when there is no clinical evidence for CVD. Furthermore, vitamin D seems to may have a role in the endothelial homeostasis and myocardial function.

Further studies on larger sample sizes could clarify whether a supplementation of Vitamin D could modify PHCs levels inflammatory indices, myocardial function and arterial stiffness in patients affected by PsA, therefore contributing to reduce cardiovascular risk in this patients.

References

  1. Gladman DD, Ang M, Su L, et al. Cardiovascular morbidity in psoriatic arthritis.Ann Rheum Dis 2009;68:1131–5.

  2. Han C et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis.J Rheumatol 2006;33:2167–72.

  3. Lo Gullo A al. Vitamin D Status in Rheumatoid Arthritis: Inflammation, Arterial Stiffness and Circulating Progenitor Cell Number. PLoS One. 2015 Aug 4;10(8):e0134602.

  4. Assalin HB, Rafacho BP, dos Santos PP, et al. Impact of the length of vitamin D deficiency on cardiac remodeling. Circ Heart Fail. 2013;6:809–16.

References

Disclosure of Interest None declared

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