Cardiac Abnormalities in Psoriasis

ABSTRACT

Introduction: Psoriasis is considered an independent cardiovascular risk factor. This study aims to determine and describe the cardiac abnormalities using echocardiography and electrocardiography in patients with plaque psoriasis. Methods: This is a case control study of psoriasis patients with no previous history of cardiac disease. One hundred and thirty-five patients attending the Dermatology Clinic, Hospital Kuala Lumpur were recruited over one year. A full history, physical examination, echocardiogram and electrocardiogram were done. The controls were 135 age and sex matched healthy individuals. Results: The psoriasis group had a significantly higher body mass index and blood pressure. The echocardiogram showed that the mean left ventricular wall diastolic thickness, aortic annulus diameter and isovolumetric relaxation time of the left ventricle was significantly prolonged, and a higher prevalence of tricuspid regurgitation in psoriasis. On the electrocardiogram, more psoriasis patients had left ventricular hypertrophy, ischaemia and right bundle branch block. The QRS interval was significantly shorter in these patients. The tricuspid valve E/A ratio was significantly lower in patients with psoriatic arthropathy. The mitral valve early filling velocity deceleration time, tricuspid valve E/A ratio and QRS interval were significantly higher among systemic therapy naïve patients. The mean mitral and tricuspid valve E/A ratio were significantly lower; and the mean ascending aorta diameter larger, in those with psoriasis for more than ten years. Conclusion: Psoriasis may be associated with an increased risk of cardiac abnormalities suggesting diastolic dysfunction and tricuspid regurgitation. These abnormalities appear to be related to disease duration. Further studies employing newer echocardiographic and cardiac imaging techniques are needed to validate this.