Associations between cardiac biomarkers and cardiac structure and function in patients with psoriasis

Introduction

Individuals with psoriasis are at increased risk of developing cardiovascular disease, often preceded by subclinical structural and functional changes. How cardiac biomarkers relate to echocardiographic measures of cardiac structure and function in this population remains incompletely understood.

Aim

We aimed to assess whether plasma levels of high-sensitivtity troponin I (TnI) and N-terminal pro-B-type natriuretic peptide (proBNP) were associated with cardiac structure and function in patients with psoriasis.

Methods

A prospective cohort of 1,010 patients with psoriasis underwent transthoracic echocardiography and blood sampling between 2021-2024. Patients with unavailable TnI and proBNP measurements were excluded. Cross-sectional associations between biomarkers, cardiovascular risk factors and echocardiographic measures were examined using ANOVA, Kruskal–Wallis, χ² tests, linear regression and heat maps. TnI and proBNP were dichotomized by their medians and combined into four categories for baseline analyses and log-transformed and analyzed as continuous variables in regression models adjusted for sex, age, smoking, BMI, hypertension, hypercholesterolemia, diabetes, chronic kidney disease, ischemic heart disease (IHD), heart failure (HF), and atrial fibrillation (AF).

Results

We included 974 patients with psoriasis (mean age 54.0 years, 55.1 % men, median TnI 3.0 ng/L (IQR 1.2-6.0), median proBNP 7.6 ng/L (4.3-14.6)). Patients with TnI and/or proBNP levels above the median were older and had a higher prevalence of comorbidities.

Higher levels of TnI were associated with increased left ventricular (LV) mass, lower LVEF, worse diastolic function, larger left atrial volume index (LAVi) and lower peak atrial longitudinal strain (PALS). Higher levels of proBNP were associated with increased LV mass, lower LVEF and global longitudinal strain, worse diastolic function, larger LAVi, and lower PALS and peak atrial contraction strain (PACS). These associations largely persisted after adjustment. (Table). In models including both biomarkers, TnI was more closely related to LV structural measures and lower e’ velocities, whereas proBNP showed broader associations with LVMi and multiple markers of diastolic dysfunction and altered left atrial strain. (Figure)

In sensitivity analyses excluding participants with known heart disease including IHD, HF, AF and valvular disease, associations were attenuated but remained statistically significant.

Conclusion

In patients with psoriasis examined in an outpatient setting, higher TnI and proBNP levels were independently associated with increased LV mass, impaired diastolic function and larger left atria with reduced strain. These associations persisted, although attenuated, after exclusion of patients with known heart disease, suggesting that TnI and proBNP may help identify subclinical cardiac remodeling in psoriasis.