Background/Introduction: Psoriatic arthritis (PsA) is a systemic inflammatory disease affecting 15-30% of patients with psoriasis. Patients with PsA present 43% higher risk of cardiovascular disease compared to non-psoriatic patients. However, the probable existence of subclinical myocardial dysfunction in these patients has not been fully elucidated. Purpose Purpose of this study is to evaluate systolic and diastolic myocardial function in asymptomatic patients with PsA and no cardiac comorbidities and to reveal the value of speckle tracking echocardiography in this object. Methods Sixty patients (29 males, mean age 52.55) and 34 healthy controls (18 males, mean age 50.79) participated the study. They were subjected to TTE to evaluate left ventricular systolic function with conventional indexes such as ejection fraction (EF) and with novel indexes such as global longitudinal strain (GLS); diastolic dysfunction was also assessed in both groups. Blood exams were conducted including crp, esr. Severity scales of the disease such as PASI and DAS 28 scores, and the duration of the disease were also recorded. Results Linear regression analysis showed significantly impaired global longitudinal peak systolic strain (GLS) in PsA patients (mean =-19.79, s.d. =4.54) compared to the controls (mean =-23.67, s.d. =3.27). Ejection fraction, on the contrary, did not show any significant difference between the two groups. Left ventricular diastolic function did not present significant difference between the two groups. Comparison of GLS with PASI and DAS 28 scores, disease duration, esr and crp showed no association. Conclusions PsA patients present a higher risk of left ventricular systolic dysfunction. GLS is a useful tool in revealing myocardial impairment. Moreover, this high risk for systolic dysfunction did not appear to correlate with disease severity markers. Systolic and diastolic function indexes GroupStatistics group N Mean Std. Deviation Std. ErrorMean p-value E/A Cases 60 1,1510 ,49319 ,06367 0,971 Controls 34 1,1471 ,53555 ,09185 E/E" (average) Cases 60 8,21 3,016 ,389 0,703 Controls 32 7,95 3,096 ,547 GLS (%) Cases 52 -19,795 4,5495 ,6309 <0,001 Controls 34 -23,671 3,2668 ,5602 EF(%) Cases 59 59,24 3,919 ,510 0,986 Controls 34 59,26 10,880 1,866 Differences between PsA patients and control group Abstract P1767 Figure. GLS in PsA patients and control group
Background:Psoriatic arthritis (PsA) is a systemic inflammatory disease affecting 15-30% of patients with psoriasis1. Patients with PsA present 43% higher risk of cardiovascular disease, involving myocardial infarction, heart failure and cerebrovascular events compared with the general population2. The common underlying pathophysiologic basis of these clinical events is early atherosclerosis. Myocardial fibrosis in the context of systemic inflammation3 seems to play a significant role in the cardiac manifestations of the disease as well. However, only a few trials have evaluated the possibility of recognition of myocardial involvement in its subclinical phase, which might be of value in reducing the morbidity and mortality of the disease.Objectives:Our goal was to evaluate the systolic and diastolic myocardial function in asymptomatic patients with PsA and no cardiac comorbidities and emphasize the value of speckle tracking echocardiography in this condition.Methods:Sixty patients (29 males) and 34 healthy controls (18 males) participated in the study. The patients’ mean age was 52.5 (s.d = 11.29) and the controls’ mean age was 50.7 years (s.d. = 17.42). They were all subjected to 2D transthoracic echocardiography, tissue Doppler imaging, and speckle tracking echocardiography, in order to evaluate left ventricular systolic function with conventional indices such as ejection fraction (EF), and with novel indices such as global longitudinal strain (GLS). Diastolic dysfunction was also assessed in both groups. Blood tests including CRP and ESR were conducted. Disease duration and severity scores, PASI and DAS 28, were also recorded. The statistical analysis was conducted with SPSS v.23.0.Results:Linear regression analysis showed statistically significantly impaired left ventricular systolic function (p<0,001), as assessed with global longitudinal strain (GLS), in PsA patients (mean =-19.79, s.d. =4.54) compared to the controls (mean =-23.67, s.d. =3.27). The results were adjusted for age and gender. Ejection fraction, on the contrary, did not show any statistically significant difference between the two groups (p=0,535). Left ventricular diastolic function did not present significant difference between the two groups. GLS showed no association with disease duration, severity scores or the blood tests.Conclusion:PsA patients present a higher risk of left ventricular systolic dysfunction compared to controls. GLS measured by speckle tracking echocardiography is a useful tool in revealing this subclinical myocardial impairment.References[1] Gladman DD, antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis2005;64Suppl 2:ii14–7[2] Polachek a, Touma Z, anderson M, Eder L. Risk of Cardiovascular Morbidity in Patients with Psoriatic arthritis: a Meta-Analysis of Observational Studies. Arthritis Care & Research Vol. 69, No. 1, January2017, pp 67–74[3] Kania G, Blyszczuk P, Eriksson U. Mechanisms of cardiac fibrosis in inflammatory heart disease. Trends Ca...
Takotsubo syndrome (TS) is typically characterized by transient (reversible) systolic dysfunction of the apical and mid segments of the left ventricle (LV), usually without obstruction of coronary arteries, in postmenopausal women after a stressful event. Usually, patients may experience symptoms such as chest pain, shortness of breath, palpitations, and rarely syncope or cardiogenic shock. There are many theories about pathophysiology of TS. Among these, most acceptable is the catecholamine theory. The prognosis is usually good with recovery of symptoms and imaging findings at most within a few weeks. However, complications may occur. We present the 11th published case of a patient on hemodialysis, who presented with TS and discuss why this situation may occur in patients on hemodialysis. Contrary to our patient, half of previously published cases presented with atypical symptoms. Therefore, it is important to be alert in order to timely diagnose, support the patient, and treat if any complications appear.
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