Rapid Fire Session

Session: Rapid Fire Session 5: Tissue Characterization, Mapping, Standardization (Monitor 7)

Cardiovascular structure, function and myocardial energetics in Psoriatic Arthritis using cardiac magnetic resonance and 31-P spectroscopy

Saturday, February 7, 2026

10:15 AM - 10:22 AM

Location: Galapagos / Aruba / Ilhabela (2nd Lower Level)

Presenting Author(s)

RJ

Rabeia Javid, BSc, MB

Cardiology Registrar
University of Leeds
Bradford, England, United Kingdom

Primary Author(s)

CY

Chin Yit Soo, MD

Clinical Research Fellow
University of Leeds
Leeds, England, United Kingdom

Co-Author(s)

RJ

Rabeia Javid, BSc, MB

Cardiology Registrar
University of Leeds
Bradford, England, United Kingdom
MH

Marzo-Ortega Helena, PhD

Professor of Rheumatology
1. NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK 2. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, United Kingdom
KM

Katya Meridor, MD

Rheumatologist
1. NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK 2. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, United Kingdom
DM

Dennis McGonagle, PhD

Professor of Rheumatology
1. NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK 2. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, United Kingdom
JF

Jane Freeston, MD

Consultant Rheumatologist
1. NIHR Leeds Biomedical Research Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK 2. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom, United Kingdom
LC

Lizette Cash, MRT

Operational Radiographer (Cross-Sectional)
Department of Biomedical Imaging Science, Leeds, United Kingdom & Advanced Imaging Centre, Leeds Teaching Hospitals NHS Trust, United Kingdom
Leeds, England, United Kingdom
TA

Thomas Anderton, MBChB

Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom
Leeds, England, United Kingdom
ML

May Lwin, MB

Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom
Leeds, England, United Kingdom
BC

Bradley Chambers, MBChB BSc MRCP

Cardiology Registrar
University of Leeds, England, United Kingdom
MA

Mehak Asad, MD, MPH

Clinical research fellow
University of Leeds, Multidisciplinary Cardiovascular Research Centre and Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, LS2 9JT, United Kingdom
Leeds, England, United Kingdom
Maryum Farooq, MB

Research Fellow
Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds
Leeds, England, United Kingdom
CS

Ching-Hui Sia, MD

Dr
Leeds Institute of Cardiovascular and Metabolic Medicine, United Kingdom
MT

Masafumi Takafuji, MD, PhD

Assistant Professor
Mie University Hospital
Tsu, Mie, Japan
MA

Mohd Imree Azmi, MB

Consultant Radiologist
University of Leeds
Leeds, England, United Kingdom
RT

Raluca Tomoaia, MD, PhD

Clinical Research Fellow
University of Leeds
Leeds, England, United Kingdom
EL

Eylem Levelt

Baker Heart and Diabetes Institute, Australia
Peter Kellman, PhD

Senior Scientist
National Institutes of Health
Bethesda, Maryland, United States
DB

David A. Broadbent, PhD

Principal Clinical Scientist (MRI Physics)
Leeds Institute of Cardiovascular and Metabolic Medicine, England, United Kingdom
LB

Lesley-Anne Bissell, PhD

Consultant Rheumatologist
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds
Leeds, England, United Kingdom
Sven Plein, MD, PhD

Professor of Cardiology
Leeds Institute of Cardiovascular and Metabolic Medicine
Leeds, England, United Kingdom
Nicholas Jex, PhD

Cardiologist
University of Leeds
Leeds, England, United Kingdom

Background: Psoriatic arthritis (PsA) is associated with markedly increased risks of cardiovascular (CV) mortality (84%) and myocardial infarction (MI) (41%) which are thought to be largely related to concomitant metabolic syndrome. Structural and morphological CV manifestations of PsA have not been studied using multi-parametric cardiac magnetic resonance (CMR).

Methods: Fifteen PsA patients (median disease duration 4.3 years) with no history of diabetes or CV disease and 20 age, sex and body mass index (BMI) matched healthy volunteers [HV] underwent 31 P magnetic resonance spectroscopy (MRS) and comprehensive CMR on a Siemens 3 Tesla PRISMA MR system (Erlangen, Germany). The protocol included volumetric imaging, aortic distensibility (descending thoracic aorta), quantitative myocardial perfusion with automated in-line perfusion mapping, T1 and T2 mapping, and late gadolinium enhancement (LGE)(Kellman P et al, JCMR 2016).
31P-MRS data were acquired with a non-gated 3D acquisition weighted chemical shift imaging (CSI) technique with 10 averages at the centre of K-space and ultrashort echo time (TE) to minimise T2 effects and first order phase artefacts. 31P-MRS post processing analysis was performed on a custom Matlab software (Mathworks, Natick, Mass) (Purvis LAB at el, PLos One 2017).

Results: Bi-ventricular volumes, systolic function, global longitudinal strain, maximal LV wall thickness and left atrial function were normal in both groups with no significant differences between PsA patients and HVs. Left ventricular (LV) ejection fraction was slightly higher in PsA patients and indexed LV end-diastolic volume lower than in HVs. There was no significant difference in aortic distensibility (table-1).

There was no significant difference in mean native T1 value and extracellular volume or T2 between the groups. Two PsA patients had LGE (all non-ischaemic pattern) (p=0.2092) vs no LGE in HVs.

No significant difference was seen in stress myocardial blood flow (MBF) between the groups. In PsA, rest MBF (HV: 0.7 ± 0.1, PsA: 0.8 ± 0.2, p=0.0308) was significantly higher leading to significantly reduced myocardial perfusion reserve (MPR) (HV: 3.7 ± 0.8, PsA: 3.0 ± 0.7, p=0.0175).

There was a trend towards lower PCr/ATP ratio in PsA without statistical significance (p=0.0787). No significant difference in PCr/ATP ratio in PsA with and without metabolic syndrome (p=0.816)(AHA diagnostic criteria, G SM et al, 2005 Circulation).

Conclusion: We report for the first time structural and functional CV manifestations in a cohort of PsA patients without diabetes. We found non-ischaemic fibrosis in 2 of 14 patients and reduced MPR with small but non-significant reductions in myocardial energetics. These data provide first mechanistic insight into the CV impact of PsA and point towards predominantly vascular mechanisms even in the absence of diabetes, rather than impaired energetics or inflammation as seen in other immune mediated inflammatory conditions.

Table 1 Clinical, CMR and 31 P MRS findings

	HV (n=20)	PsA (n=15)	P value
Age, y	43 ± 12	43 ± 11	0.9298
Female, n (%)	15 (75)	10 (67)	0.7118
BMI, kg/m²	27 ± 5	29 ± 6	0.2775
Systolic BP, mmHg	123 ± 12	123 ± 19	0.6238
On ≥1 DMARD	-	15 (100)	-
On ≥ 2 DMARDs	-	2 (13)	-
Disease duration, y	-	4.3 [1, 10]	-
Metabolic syndrome, %	-	5 (33)	-
Systemic hypertension, %	-	2 (13)	-
NT- Pro BNP, ng/L	62 [45-94]	46 [35-142]	0.3145
Troponin I, ng/L	3 [3-5]	3 [3-3]	0.0496
Total cholesterol, mmol/L	5.1 [4.3-5.6]	4.9 [4-5.5]	0.6130
HbA1c, mmol/mol	35 ± 3	34 ± 3	0.3684
Triglyceride Glucose index	3.5 ± 1.3	4.1 ± 1.8	0.3533
CRP, mg/L	5 [5-5]	5 [5-13]	0.1677
LV end-diastolic volume indexed to BSA, mL/m²	84 ± 14	80 ± 12	0.3203
LV end-systolic volume indexed to BSA, ml/m²	33 ± 6	28 ± 6	0.0466
LV mass index, g/m²	50 ± 8	50 ± 12	0.9039
LV mass to LV end-diastolic volume, g/mL	0.6 ± 0.1	0.6 ± 0.1	0.6671
LV stroke volume, ml	97 ± 18	99 ± 21	0.8265
LV ejection fraction, %	61 ± 4	65 ± 4	0.0107
LV maximal wall thickness, mm	8 [7-8]	8 [7-9]	0.9215
RV end-diastolic volume indexed to BSA, mL/m²	86 ± 13	84 ± 14	0.6273
RV end-systolic volume indexed to BSA, ml/m²	35 ± 8	34 ± 8	0.5794
RV ejection fraction, %	58 [56-61]	59 [58-62]	0.6194
LA biplane end-systolic volumes, mL	65 ± 22	65 ± 13	0.9288
Bi-plane LA ejection fraction, %	59 ± 8	60 ± 6	0.5705
Global longitudinal strain, negative (-), %	18 ± 2	19 ± 3	0.8533
Mean native T1, (ms)	1317 ± 28	1330 ± 29	0.1935
Extra cellular volume, (%)	23 [22-25]	24 [21-26]	0.9759
LGE, n (%)	0	2 (14)	0.2092
LGE with non-ischaemic pattern, n (%)	-	2 (100)	-
Mean native T2, (ms)	42 ± 2.5	43 ± 3	0.2129
Aortic distensibility, (10-3 mmHg-1)	5.5 [4.3-8.4]	4.7 [3.4-8.5]	0.6749
PCr/ATP ratio	2.4 [2.3-3.1]	2.2 [1.7-2.6]	0.0787
Stress MBF, ml/min/g	2.6 ± 0.5	2.6 ± 0.6	0.9580
Rest MBF, ml/min/g	0.7 ± 0.1	0.8 ± 0.2	0.0308
MPR	3.7 ± 0.8	3.0 ± 0.7	0.0175

Values are means ± standard deviations for continuous data, numbers (percentages), or median [inter-quartile ranges] for non-continuous data. HV, healthy volunteer; PsA, psoriatic arthritis; BMI, body mass index; BP, blood pressure; DMARD, disease-modifying anti-rheumatic drug; NTproBNP, N-terminal pro-B-type natriuretic peptide; HbA1c, Haemoglobin A1c; CRP, C-polysaccharide reactive protein; LV, left ventricle; BSA, body surface area; RV, right ventricle; LA, left atrium; LGE, late gadolinium enhancement; PCr, phosphocreatine; ATP, adenosine tri-phosphate; MBF, myocardial blood flow; MPR, myocardial perfusion reserve.Figure 1: Scatter plots of stress myocardial blood flow (MBF), rest MBF, myocardial perfusion reserve (MPR), in healthy volunteers (HV) vs psoriatic arthritis (PsA)
Scatter plot of PCr/ATP in HV versus PsA, and a representative spectrum (black) and fit (red) showing phosphocreatine (PCr) to ATP ratio (PCr/ATP = 2.23) in a healthy control.