Abstract 12622: Treatment With Biological Agents Improves Endothelial and Coronary Artery Function in Parallel With Left Ventricular Deformation and Twisting in Patients With Psoriasis
The role of treatment with biological agents on vascular and LV function in psoriasis is unclear.
Methods: Sixty patients (age:50±12 yrs) with psoriasis(PS) (PASI disease activity score:11.5±8) were randomized to receive an anti-TNF-a (n=20),an anti-IL12/23 regimen (n=20) or a combined cyclosporine and methotrexate(n=20). At baseline and after 4 months of treatment, we measured a)the carotid-femoral pulse wave velocity (Complior-PWVc) and augmentation index (AI) central systolic blood pressure (cSBP) and pulse wave velocity(PWVa) by Arteriograph b) flow-mediated dilation of the brachial artery (FMD) and carotid intima-media thickness(IMT) c) E’/A of mitral annular velocities ,LV longitudinal (GLS -%),strain,twisting (Tw -deg),peak twisting (Tw-deg/sec)velocity,untwisting at mitral valve opening (unTw) and untwisting (unTw)velocity using speckle tracking echocardiography d) coronary flow reserve(CFR).Forty normal subjects (N) served as controls.
Results: At baseline patients with psoriasis had higher PWVc,PWVa,AI,IMT, Tw,Tw velocity,unTw velocity and lower CFR,E’/A’,GLS than normals(p≤0.05). risk factors age and sex were similar between the treatment groups.Four months post-treatment, patients treated with biological agents(n=40) had higher FMD (11±6 vs.5±4),CFR(3.3±1.4 vs. 2.6±1),E’/A ’(0.94±0.3 vs.0.74±0.3) and reduced E/E’ (8.3±3 vs.9.4±3),Tw (15±6 vs.17±9),Tw velocity(97±45 vs.110±48),untwisting at mitral valve opening (8.3±3 vs.9.4±3)and unTw velocity (100±44vs.120±60)(p≤0.05 for all comparisons) showing values similar to those in controls (p=ns).No differences between anti-TNFa and anti-IL-12/23 were detected.Conversely,after treatment,patients on cyclosporine and methotrexate had no change in FMD (6.6±6v s.6.3±4),CFR (2.7±1.4 vs.2.9 ±1),E’/A ’(0.89±0.3 vs.0.91±0.3) but an increase in AI (34±19 vs.26±22),cSBP (135±22vs.128±15),Tw (15±5vs.13±6) and unTw velocity(110±59vs.98±55) (p≤0.05 for all comparisons).PASI was similarly improved in all treatment arms
Conclusion: Treatment with biological agents improves endothelial and coronary microcirculatory function leading to improved LV myocardial deformation and twisting.
- © 2013 by American Heart Association, Inc.