Cardiac manifestations of psoriasis and palmoplantar pustulosis: the PSOCADIA study

Background Severe psoriasis is associated with increased risk of adverse cardiovascular events, but the impact of psoriasis on cardiac structure and function is underexplored. Purpose We aimed to determine the prevalence of myocardial dysfunction in individuals with psoriasis and/or palmoplantar pustulosis (PPP) compared to controls without inflammatory skin disease. Methods A total of 1,042 prospectively included individuals with psoriasis and/or PPP and 1,042 age and sex-matched controls without inflammatory skin disease were examined with transthoracic echocardiography. Prevalence of cardiometabolic risk factors and cardiac abnormalities were compared between groups using ANOVA, Pearsons Chi2 test and/or Kruskal-Wallis test as appropriate. Left ventricular (LV) systolic dysfunction (SDF) was defined as LVEF <50% and/or global longitudinal strain (GLS) <16%. Diastolic dysfunction was defined according to ASE guidelines; 1) Presence of SDF and/or myocardial disease or 2) at least two impaired diastolic parameters (E/e’ >14, septal e’ velocity <7cm/s, lateral e’ velocity <10 cm/s, left atrial volume index (LAVi) >34 mL/m2, or tricuspid regurgitation velocity (TR Vmax) >2.8 m/s). Results Individuals with psoriasis and/or PPP had significantly higher weight, BMI, and diastolic blood pressure, and current/prior tobacco use was more common compared to controls (p < 0.001 for all) (Table). The majority of individuals with psoriasis and/or PPP had moderate-to-severe psoriasis (72.1%), with biologics (42.7%) and methotrexate (22.2%) being the most common treatments. Individuals with psoriasis and/or PPP had a significantly higher prevalence of obesity (26.0% vs. 15.1%, p<0.001), hypertension (29.6 vs. 19.6%, p<0.001), dyslipidemia (69.8% vs. 62.9%, p<0.001), diabetes (9.0% vs. 3.4%, p<0.001), and chronic kidney disease (2.1% vs. 0.5%, p<0.001) compared to controls. The prevalence of atherosclerotic cardiovascular disease was comparable between groups (4.3% vs. 2.8%, p=0.06). The psoriasis/PPP group exhibited a higher prevalence of both RV SDF determined by TAPSE < 1.8 cm (16.0% vs. 2.5%, p<0.001) and LV SDF compared to controls (22.8 vs. 15.4%, p<0.001) (Figure), LV SDF primarily driven by impairment in GLS (GLS <16%: 16.6% vs. 6.0%, p<0.001). No significant differences were observed in prevalence of decreased LVEF. Similarly, LV DDF prevalence was comparable between groups (27.7% vs. 28.7%, p=0.63), with no significant differences in altered E/e’ or e’ lateral velocity. Conclusion Individuals with psoriasis and/or PPP exhibited a higher prevalence of cardiometabolic risk factors and subclinical RV and LV systolic dysfunction compared to controls without inflammatory skin disease. The clinical significance of these cardiac alterations in psoriasis warrants further investigation.