Endothelial Glycocalyx Integrity and Microvascular Perfusion Are Associated with Novel Echocardiographic Markers and Carotid Intima–Media Thickness in Patients with Psoriasis - European Medical Journal

Endothelial Glycocalyx Integrity and Microvascular Perfusion Are Associated with Novel Echocardiographic Markers and Carotid Intima–Media Thickness in Patients with Psoriasis

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*Ignatios Ikonomidis,1 George Pavlidis,1 John Thymis,1 Pinelopi Rafouli-Stergiou,1 George Makavos,1 Gavriella Kostelli,1 Agathi-Rosa Vrettou,1 Alexandra Frogoudaki,1 Pelagia Katsimbri,2 Vaia Lambadiari,3 John Parissis,1 Efstathios Iliodromitis,1 Konstantinos Theodoropoulos,4 Eirini Kapniari,4 Evangelia Papadavid4

The authors have declared no conflicts of interest.

EMJ Cardiol. ;9[1]:35-36. Abstract Review No. AR1.
Carotid intima–media thickness, coronary flow reserve, endothelial glycocalyx, myocardial deformation, psoriasis.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.


Psoriasis has been associated with vascular and myocardial dysfunction through mechanisms of inflammation and oxidative stress.1,2

The authors’ aim was to evaluate sublingual microvascular perfusion and glycocalyx barrier properties in patients with psoriasis, as well as their correlation with coronary microcirculatory function and markers of myocardial deformation and atherosclerosis (carotid intima-media thickness [cIMT]).


The authors examined 297 patients with psoriasis and 150 controls, adjusted for age, sex, and atherosclerotic risk factors. Perfusion boundary region (PBR), a marker of glycocalyx barrier function, was measured non-invasively in sublingual microvessels, with a diameter ranging from 5 μm to 25 μm, using a dedicated camera (Sidestream Dark Field imaging, Microscan, GlycoCheck). An increased PBR indicates reduced glycocalyx thickness. Indexes of microvascular perfusion including red blood cell (RBC) filling percentage and functional microvascular density were also calculated.3 The authors measured coronary flow reserve, cIMT, and myocardial deformation markers by speckle tracking imaging, utilising echocardiography (peak twisting; the percentage changes between peak twisting and untwisting at mitral valve opening [%dpTw-UtwMVO], at peak [%dpTw-UtwPEF], and at the end of early left ventricular diastolic filling [%dpTw-UtwEDF]).


Patients with psoriasis had higher PBR5-25 compared to controls (2.13±0.29 versus 1.78±0.25 μm; p<0.05). There was an inverse association of PBR5-25, with perfused microvascular density (r=-0.42; p<0.001) and RBC fraction (r=-0.80; p<0.001). In the population of people with psoriasis, PBR5-25 was inversely correlated to coronary flow reserve (r=-0.30; p=0.045). Increased values of PBR5-9 were associated with reduced untwisting at the end of the mitral inflow E wave (r=-0.24; p=0.006) and reduced %dpTw-UtwMVO (r=-0.35; p<0.001). Furthermore, the decreased RBC filling percentage and perfused microvascular density were related to worse left ventricular longitudinal strain and increased cIMT (p<0.05). Finally, a positive correlation between perfused microvascular density and %dpTw-UtwMVO was observed in patients with psoriasis (p<0.05).


Endothelial glycocalyx thickness is reduced in patients with psoriasis and is associated with impaired coronary and myocardial function and vascular atherosclerosis.

Lazou A et al. Chronic inflammatory diseases, myocardial function and cardioprotection. Br J Pharmacol. 2020;177(23):5357-74. Makavos G et al. Effects of interleukin 17A inhibition on myocardial deformation and vascular function in psoriasis. Can J Cardiol. 2020;36(1):100-11. Lee DH et al. Deeper penetration of erythrocytes into the endothelial glycocalyx is associated with impaired microvascular perfusion. PLoS One. 2014;9(5):e96477.

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