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Endothelial glycocalyx and microvascular perfusion are associated with carotid intima-media thickness and impaired myocardial deformation in psoriatic disease

Journal of Human Hypertension volume 36, pages 1113–1120 (2022)Cite this article

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Abstract

Psoriatic disease is associated with vascular and myocardial dysfunction. We aimed to evaluate endothelial glycocalyx barrier properties and microvascular perfusion in psoriatic patients, as well as their correlation with carotid intima-media thickness (cIMT) and markers of left ventricular (LV) myocardial deformation. We examined 297 psoriatic patients and 150 controls, adjusted for age, sex, and atherosclerotic risk factors. The severity of psoriatic disease was estimated using the psoriasis area and severity index (PASI). Perfused boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels with a diameter 5–25 μm using Sidestream Dark Field camera (Microscan, GlycoCheck). Increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion, including red blood cells filling (RBCF) and functional microvascular density, were also calculated. We measured cIMT, coronary flow reserve (CFR) and markers of myocardial deformation by speckle-tracking imaging, namely global longitudinal strain (GLS) and percentage changes between peak twisting and untwisting at mitral valve opening (%dpTw-UtwMVO). Compared to controls, psoriatic patients had higher PBR5-25μm (2.13 ± 0.29μm versus 1.78 ± 0.25μm, p < 0.001) and lower RBCF and functional microvascular density (p < 0.001). Increased PASI was associated with elevated PBR and more impaired cIMT and GLS (p < 0.05). There was an inverse association of PBR with RBCF and functional microvascular density (p < 0.001). In psoriatic population, increased PBR was related to increased cIMT, reduced CFR, impaired GLS and decreased %dpTw-UtwMVO (p < 0.001). Glycocalyx thickness is reduced in psoriatic patients, which in turn impairs microvascular perfusion, and is associated with carotid IMT and impaired coronary and myocardial function.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT02144857.

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Fig. 1: Indices of endothelial glycocalyx thickness and microvascular perfusion in patients with psoriatic disease versus healthy controls.
Fig. 2: Association of endothelial glycocalyx with vascular and myocardial function.

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Authors and Affiliations

  1. 2nd Department of Cardiology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece

    Ignatios Ikonomidis, George Pavlidis, Pinelopi Rafouli-Stergiou, George Makavos, John Thymis, Gavriella Kostelli, Maria Varoudi, Konstantinos Katogiannis & John Parissis

  2. 2nd Department of Internal Medicine Propaedeutic, Research Institute and Diabetes Center, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece

    Vaia Lambadiari

  3. 2nd Department of Dermatology and Venereology, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece

    Konstantinos Theodoropoulos & Evangelia Papadavid

  4. 4th Department of Internal Medicine, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece

    Pelagia Katsimbri

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  1. Ignatios Ikonomidis
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Contributions

II, GP and VL: designed the study, analyzed the data, drafted the initial manuscript, revised and approved the final version; PRS, GM, JT, GK, MV, KK, KT, PK: performed data collection and approved the final version; JP and EP: designed the study and edited, revised and approved the final version.

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Correspondence to Ignatios Ikonomidis.

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Ikonomidis, I., Pavlidis, G., Lambadiari, V. et al. Endothelial glycocalyx and microvascular perfusion are associated with carotid intima-media thickness and impaired myocardial deformation in psoriatic disease. J Hum Hypertens 36, 1113–1120 (2022). https://doi.org/10.1038/s41371-021-00640-2

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