Non-ischemic Primary and Secondary Cardiomyopathy
Jan Gröschel, MD
MD
Charité – Universitätsmedizin Berlin, ECRC, MDC, DZHK, Germany
Leonhard Grassow
Doctoral Student
Charité – Universitätsmedizin Berlin, Germany
Jan Gröschel, MD
MD
Charité – Universitätsmedizin Berlin, ECRC, MDC, DZHK, Germany
Edyta Blaszczyk, MD
Dr
Charité – Universitätsmedizin Berlin
Berlin, Berlin, Germany
Kerstin Lommel, MD
Physician
HELIOS Hospital Berlin-Buch, Germany
Georgios Kokolakis, MD
Physician
Charité – Universitätsmedizin Berlin, Germany
Robert Sabat, MD
Physician
Charité – Universitätsmedizin Berlin, Germany
Jeanette Schulz-Menger, MD
Professor
Charité – Universitätsmedizin Berlin, ECRC, MDC, Helios Klinikum Berlin Buch, DZHK, Berlin, Germany
Berlin, Berlin, Germany
Psoriasis is a chronic systemic inflammatory disorder with primary manifestation on the skin (1). Cardiovascular morbidity and mortality are high among these patient groups (2-4). Despite the frequent cardiovascular involvement, no prospective data regarding potential underlying myocardial changes has been provided. The aim of this study is to establish an initial myocardial characterization in psoriasis by CMR and to investigate potential cardiac involvement.
Methods:
These initial results of a prospective clinical trial include 30 patients with psoriasis vulgaris (PV) free of any severe cardiovascular events or symptoms. Subjects with either mild (local therapy) or severe psoriasis (systemic therapy) were recruited from dermatological clinical routine. Due to anti-inflammatory treatment, the patients showed little or no macroscopic skin alterations (current PASI score mean±SD: 4.2±2.8). The cohort was compared to a sex- and age-matched healthy control group (HC). CMR was performed at a 1.5 T scanner (Siemens). The scan protocol included short axis (SAX) cine images for left (LV) and right (RV) ventricular function and mass as well as T1 and T2 mapping acquisition in 3 SAX slices (basal, midventricular, apical) to detect diffuse fibrosis and quantify myocardial edema. Late Gadolinium Enhancement (LGE) was performed in long axis (LAX) and SAX stack covering the whole ventricle to visualize focal fibrosis. CMR analysis was accomplished using cvi42 (version 5.13.7).
Results:
Basic characteristics: PV: n=30, mean age (years) ± SD: 48.6±15.2, 11 women (36.7%), 19 men (63.3%); HC: n=30, mean age (years) ± SD: 47.3±14.0, 15 women (50%), 15 men (50%). Nonischemic focal fibrosis was found in 5 (16.7%) psoriatic patients. LV and RV function and mass did not differ between groups. However, there was a significant difference toward native T1 values in basal measured slices: T1 basal (ms) mean ± SD: PV: 1004.7±28.8 vs HC: 989.5±24.9, p=0.033 (Table 1), indicating diffuse fibrotic changes. Interestingly, global T2 times were significantly lower in PV compared to HC. This finding could be potentially explained by the local and systemic anti-inflammatory therapy in psoriatic patients. Corresponding associations between inflammation-modulating therapy and reduced myocardial inflammation have already been observed in other diseases (5).
Conclusion:
Despite preserved LV and RV function, both focal as well as diffuse fibrotic myocardial changes were detectable in psoriatic patients. Anti-inflammatory therapy seems to have a beneficial effect on myocardial edema in systemic diseases. These results provide initial insights into myocardial characterization in psoriatic patients and encourage further research.