EARLY LEFT VENTRICULAR DYSFUNCTION, ARTERIAL STIFFNESS, PROANGIOGENIC HAEMATOPOIETIC CELLS AND VITAMIN D LEVELS IN PATIENTS WITH PSORIASIC ARTHRITIS

Background and Aims. 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 compared with controls. Recent studies have shown that PsA patients have a high prevalence of vitamin D (vit-D) deficiency; this condition that is considered an independent predictor of cardiovascular diseases and all cause mortality in several clinical settings. We aimed to evaluate left ventricular (LV) mechanics in patients diagnosed with PsA and no clinical evidence for cardiovascular disease (CVD) using a novel, 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 and Results. 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. 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. Conclusion. 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.