Sinan İNCİ, Özgül MUŞTU KORYÜREK, Gökay NAR, Gökhan AKSAN, İbrahim İZGÜ

Psoriazis Vulgarisli Hastalarda Preklinik Sol Ventrikül Fonksiyon Bozukluğunun İki Boyutlu Speckle Tracking Ekokardiyografi ile Tespiti

Giriş: Bu çalışmada bilinen kalp hastalığı olmayan psoriazis vulgaris (PV)’li hastalarda subklinik sol ventrikül işlev bozukluğunun araştırılması hedeflenmiştir. Hastalar ve Yöntem: Çalışmaya koroner arter hastalığı ve kalp yetersizliği olmayan 45 psoriazis vulgarisli hasta (22 E, 23 K, yaş 39 ± 14 yıl) ve yaş, cinsiyeti uygun 45 sağlıklı kontrol grubu alındı. Sol ventrikül işlevleri speckle tracking ekokardiyografi (STE) ile longitudinal olarak apikal 4-3-2 boşluk görüntülerle mevcut software kullanılarak analiz edildi (QLAB 6.0). Bulgular: İki grup arasında standart ekokardiyografi ve Doppler parametreleri arasında fark yoktu. Psoriazis vulgaris hastalarında bazal septum ve lateral mitral anulustan doku Doppler görüntülemede S’ ve E’ parametrelerinde anlamlı azalma görüldü. Sol ventrikül longitudinal ölçümlerde longitudinal strain ve strain hız parametreleri kontrol grubu ile karşılaştırıldığında anlamlı olarak azalmıştı. Global longitudinal strain (GLS) PV hasta grubunda %-20.8 ± 4.11 ve kontrol grubunda %-22.9 ± 3.73 olarak ölçüldü (p= 0.035). PV hasta grubunda GLS ile hastalık süresi ve şiddeti arasında anlamlı negatif korelasyon vardı. Sonuç: Çalışmamız PV’li hastaların standart ekokardiyografi parametreleri normal olmasına rağmen STE ile sol ventrikül fonksiyonlarının azaldığını göstermiştir.

Anahtar Kelimeler:

Sol ventrikül fonksiyonları, psoriazis vulgaris, speckle tracking ekokardiyografi

Determining Preclinical Left Ventricular Function Impairment with Two-Dimensional Speckle Tracking Echocardiography in Patients with Psoriasis Vulgaris

Introduction: The purpose of study was to examine subclinical left ventricular function impairment in patients with psoriasis vulgaris (PV) without any known heart diseases. Patients and Methods: In total, 45 patients (22 males and 23 females; age: 39 ± 14 years) with psoriasis vulgaris who did not have any known coronary artery disease and cardiac insufficiency and a control group consisting of 45 healthy participants whose ages and genders matched those of participants in the study group were included in our study. Left ventricular functions were longitudinally analysed with speckle tracking echocardiography (STE) and with apical 4-3-2 chamber images using the current software (QLAB 6.0). Results: There were no differences between the two groups in terms of standard echocardiography and Doppler parameters. A significant decrease was observed in S’ and E’ parameters of patients with psoriasis vulgaris on tissue Doppler imaging from the basal septum and lateral mitral annulus. Compared with the control group, the longitudinal strain and strain speed parameters were found to decrease at a significant level in left ventricular longitudinal measurements. The global longitudinal strain (GLS) was measured as -20.8 ± 4.11% in the study group and as -22.9 ± 3.73% in the control group (p= 0.035). There was a significant negative correlation between GLS and the duration and severity of disease in the study group. Conclusion: We showed that although the standard echocardiography parameters were normal, STE and left ventricular functions of patients with PV decreased.

Keywords:

Left ventricular functions, psoriasis vulgaris, speckle tracking echocardiography,

PDF

___

1. Farber EM, Nall ML. The natural history of psoriasis in 5.600 patients. Dermatologica 1974;148:1-18.
2. Bonifati C, Ameglio F. Cytokines in psoriasis. Int J Dermatol 1999;38:241-51.
3. Torok L, Toth E, Bruncsak A. Correlation between psoriasis and cardiovascular diseases. Z Hautkr 1982;57:734-9.
4. Henseler T, Christophers E. Disease concomitance in psoriasis. J Am Acad Dermatolog 1995;32:982-6.
5. Moya JL, Sanchez M, Morales MD, Brito E. Mitral valve prolapse (MVP) in psoriatic arthritis (PA). Arch Int Med 1987;147:992.
6. Teske AJ, De Boeck BW, Melman PG, Sieswerda GT, Doevendans PA, Cramer MJ. Echocardiographic quantification of myocardial function using tissue deformation imaging, a guide to image acquisition and analysis using tissue Doppler and speckle tracking. Cardiovasc Ultrasound 2007;5:27.
7. Perk G, Tunick PA, Kronzon I. Non-Doppler two-dimensional strain imaging by echocardiography–from technical considerations to clinical applications. J Am Soc Echocardiogr 2007;20:234-43.
8. Altiok E, Tiemann S, Becker M, Koos R, Zwicker C, Schroeder J, et al. Myocardial deformation imaging by two-dimensional speckle-tracking echocardiography for prediction of global and segmental functional changes after acute myocardial infarction: a comparison with late gadolinium enhancement cardiac magnetic resonance. J Am Soc Echocardiogr 2014;27:249-57.
9. Kang Y, Xu X, Cheng L, Li L, Sun M, Chen H, et al. Two-dimensional speckle tracking echocardiography combined with high-sensitive cardiac troponin T in early detection and prediction of cardiotoxicity during epirubicine-based chemotherapy. Eur J Heart Fail 2014;16:300-8.
10. Russo C, Jin Z, Elkind MS, Rundek T, Homma S, Sacco RL, et al. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Heart Fail 2014;16:1301-9.
11. Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: A report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 2002;15:167-84.
12. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.
13. Langley RG, Ellis CN. Evaluating psoriasis with psoriasis area and severity index, psoriasis global assessment and lattice system physician’s global assessment. J Am Acad Dermatol 2004;51:563-9.
14. Zhao CT, Yeung CK, Siu CW, Tam S, Chan J, Chen Y, et al. Relationship between parathyroid hormone and subclinical myocardial dysfunction in patients with severe psoriasis J Eur Acad Dermatol Venereol 2014;28:461-8.
15. Friedewald VE, Cather JC, Gelfand JM, Gordon KB, Gibbons GH, Grundy SM, et al. AJC editor’s consensus: Psoriasis and coronary artery disease. Am J Cardiol 2008;102:1631-43.
16. Gelfand JM, Dommasch ED, Shin DB, Azfar RS, Kurd SK, Wang X, et al. The risk of stroke in patients with psoriasis. J Invest Dermatol 2009;129:2411-8.
17. Mehta NN, Azfar RS, Shin DB, Neimann AL, Troxel AB, Gelfand JM. Patients with severe psoriasis are at increased risk of cardiovascular mortality: Cohort study using the General Practice Research Database. Eur Heart J 2010;31:1000-6.
18. Prodanovich S, Kirsner RS, Kravetz JD, Ma F, Martinez L, Federman DG. Association of psoriasis with coronary artery, cerebrovascular, and peripheral vascular diseases and mortality. Arch Dermatol 2009;145:700-3.
19. Armstrong AW, Voyles SV, Armstrong EJ, Fuller EN, Rutledge JC. A tale of two plaques: Convergent mechanisms of T-cell-mediated inflammation in psoriasis and atherosclerosis. Exp Dermatol 2011;20:544-9.
20. Rico T, Marchione R, Kirsner RS. Vascular disease in psoriasis. J Invest Dermatol 2009;129:2327.
21. Eliakim-Raz N, Shuvy M, Lotan C, Planer D. Psoriasis and dilated cardiomyopathy: coincidence or associated diseases? Cardiology 2008;111:202-6.
22. Prakash A, Deepshikha. Psoriasis and cardiomyopathy: an intriguing association. Indian J Dermatol 2010;55:271-3.
23. Ulusoy R, Karabudak O, Yokusoglu M, Kilicaslan F, Kirilmaz A, Cebeci B. Noninvasive assessment of impaired endothelial function in psoriasis.Rheumatol Int 2010;30:479-83.
24. Sitia S, Tomasoni L, Cicala S, Atzeni F, Ricci C, Gaeta M, et al. Detection of preclinical impairment of myocardial function in rheumatoid arthritis patients with short disease duration by speckle tracking echocardiography. Int J Cardiol 2012;160:8-14.
25. Yiu KH, Schouffoer AA, Marsan NA, Ninaber MK, Stolk J, Vlieland TV, et al. Left ventricular dysfunction assessed by speckle-tracking strain analysis in patients with systemic sclerosis: sclerosis: relationship to functional capacity and ventricular arrhythmias. Arthritis Rheum 2011;63:3969-78.
26. Saricaoglu H, Güllülü S, Bülbül Baskan E, Cordan J, Tunali S. Echocardiographic findings in subjects with psoriatic arthropathy. J Eur Acad Dermatol Venereol 2003;17:414-7.
27. Shang Q, Tam LS, Yip GW, Sanderson JE, Zhang Q, Li EK, et al. High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 2011;38:1363-70.
28. Aksan G, Nar G, Soylu K, İnci S, Yuksel S, Ocal HS, et al. Assessment of atrial electromechanical delay and left atrial mechanical functions in patients with psoriasis vulgaris. Echocardiography 2015;32:615-22.
29. Ahlehoff O, Hansen PR, Gislason GH, Frydland M, Bryld LE, Elming H, et al. Myocardial function and effects of biologic therapy in patients with severe psoriasis: a prospective echocardiographic study J Eur Acad Dermatol Venereol 2016;30:819-23.
30. Wang J, Khoury DS, Yue Y, Torre-Amione G, Nagueh SF. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Eur Heart J 2008;29:1283-9.
31. Yip GW, Zhang Q, Xie JM, Liang YJ, Liu YM, Yan B, et al. Resting global and regional left ventricular contractility in patients with heart failure and normal ejection fraction: insights from speckle-tracking echocardiography. Heart 2011;97:287-94.
32. Kania G, Blyszczuk P, Eriksson U. Mechanisms of cardiac fibrosis in inflammatory heart disease. Trends Cardiovasc Med 2009;19:247-52.
33. Russo C, Jin Z, Elkind MS, Rundek T, Homma S, Sacco RL, et al. Prevalence and prognostic value of subclinical left ventricular systolic dysfunction by global longitudinal strain in a community-based cohort. Eur J Heart Fail 2014;161301-9.
34. Stanton T, Leano R, Marwick TH. Prediction of all-cause mortality from global longitudinal speckle strain: comparison with ejection fraction and wall motion scoring. Circ Cardiovasc Imaging 2009;2:356-64.
35. Motoki H, Borowski AG, Shrestha K, Troughton RW, Tang WH, Thomas JD, et al. Incremental prognostic value of assessing left ventricular myocardial mechanics in patients with chronic systolic heart failure. J Am Coll Cardiol 2012;60: 2074-81.
36. Yagmur J, Sener S, Acikgoz N, Cansel M, Ermis N, Karincaoglu Y, et al. Subclinical left ventricular dysfunction in Behcet’s disease assessed by two-dimensional speckle tracking echocardiography. Eur J Echocardiogr 2011;12:536-41.

ISSN: 2149-2972
Yayın Aralığı: Yılda 3 Sayı
Başlangıç: 1990
Yayıncı: Sağlık Bilimleri Üniversitesi, Kartal Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi