Assessment of Subclinical Atherosclerosis in Patients with Psoriasis Using Echocardiographic Coronary Flow Reserve Parameters: A Systematic Review and Meta-Analysis.

Abstract

Aims/Background Psoriasis is a chronic inflammatory condition associated with an elevated risk of cardiovascular diseases including coronary artery disease (CAD). This study assessed coronary microvascular dysfunction (CMD) in psoriasis patients using echocardiographic coronary flow parameters, controlling for traditional cardiovascular risk factors and atherosclerosis, to fill gaps identified in previous research. Methods A comprehensive literature search was performed using multiple electronic databases for studies on echocardiographic coronary flow parameters in patients with psoriasis. The outcomes of interest included the coronary flow velocity reserve (CFVR), hyperemic diastolic peak flow velocity (DPFV), and baseline DPFV. Data were extracted and analyzed using RevMan 5.4 (Nordic Cochrane Center, Copenhagen, Denmark), with pooled standard mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Statistical significance was set at p < 0.05. Results Four studies involving 557 patients were included in this analysis. Pooled analysis revealed a significant reduction in CFVR in patients with psoriasis compared to controls (SMD: -0.71; 95% CI: -0.97, -0.45; p < 0.00001). Hyperemic DPFV was significantly reduced (SMD: -0.71; 95% CI: -1.30, -0.12; p = 0.02), whereas baseline DPFV showed no signficant difference (SMD: 0.20; 95% CI: -0.92, 1.32; p = 0.73). Conclusion Psoriasis was associated with reduced CFVR and hyperemic DPFV, suggesting early CMD. CFVR could aid in early CMD detection in psoriasis patients, informing cardiovascular risk management and potential anti-inflammatory treatment benefits. Systematic Review Registration PROSPERO: CRD42024574085.