Stefano Piaserico1, Elena Osto2, Giulia Famoso3, Irene Zanetti1, Dario Gregori3, Anna Poretto3, Sabino Iliceto3, Andrea Peserico1, Francesco Tona4. 1. Department of Medicine, University of Padova, Italy. 2. Centre for Molecular Cardiology, University of Zurich and University Heart Center, Cardiology, University Hospital Zurich, Switzerland. 3. Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. 4. Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Italy. Electronic address: francescotona@hotmail.com.
Abstract
BACKGROUND AND AIMS: In patients with psoriasis, the chronic exposure to systemic inflammation can result in coronary microvascular dysfunction (CMD). In this self-controlled, prospective pilot study, we investigated whether a long-term treatment with TNF-α inhibitors effective against skin symptoms also improves coronary flow reserve in psoriasis patients (CFR). METHODS: We prospectively studied 37 consecutive psoriasis patients (31 male; age, 37.7 ± 8.5 years) without cardiovascular disease, before and after anti-TNF-α treatment. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. A CFR≤2.5 was considered a marker of CMD. Psoriasis was assessed by Psoriasis Area and Severity Index (PASI). High sensitive C-reactive protein (hs-CRP) and serum TNF-α were assessed. RESULTS: Overall, CFR increased from 2.2 ± 0.7 to 3.02 ± 0.8 (p < 0.0001) after TNF-α inhibitors therapy. In patients with CMD, CFR increased from 1.88 ± 0.3 to 2.74 ± 0.5 (p < 0.0001). In patients with normal CFR, CFR increased from 3.0 ± 0.5 to 3.7 ± 0.9 (p = 0.08). CFR improvement after TNF-α inhibitors treatment was correlated with hs-CRP and TNF-α reduction (p = 0.004 and p = 0.02, respectively), but not with change in PASI (p = 0.5). CONCLUSIONS: The present study demonstrates that TNF-α inhibitors treatment ameliorates CMD in patients with established psoriasis not responding to long-term conventional therapy. These findings suggest that a therapy specifically targeted against inflammation is able to positively affect coronary microvascular function.
BACKGROUND AND AIMS: In patients with psoriasis, the chronic exposure to systemic inflammation can result in coronary microvascular dysfunction (CMD). In this self-controlled, prospective pilot study, we investigated whether a long-term treatment with TNF-α inhibitors effective against skin symptoms also improves coronary flow reserve in psoriasispatients (CFR). METHODS: We prospectively studied 37 consecutive psoriasispatients (31 male; age, 37.7 ± 8.5 years) without cardiovascular disease, before and after anti-TNF-α treatment. CFR in the left anterior descending coronary artery was detected by transthoracic Doppler echocardiography, at rest and during adenosine infusion. CFR was the ratio of hyperemic to resting diastolic flow velocity. A CFR≤2.5 was considered a marker of CMD. Psoriasis was assessed by Psoriasis Area and Severity Index (PASI). High sensitive C-reactive protein (hs-CRP) and serum TNF-α were assessed. RESULTS: Overall, CFR increased from 2.2 ± 0.7 to 3.02 ± 0.8 (p < 0.0001) after TNF-α inhibitors therapy. In patients with CMD, CFR increased from 1.88 ± 0.3 to 2.74 ± 0.5 (p < 0.0001). In patients with normal CFR, CFR increased from 3.0 ± 0.5 to 3.7 ± 0.9 (p = 0.08). CFR improvement after TNF-α inhibitors treatment was correlated with hs-CRP and TNF-α reduction (p = 0.004 and p = 0.02, respectively), but not with change in PASI (p = 0.5). CONCLUSIONS: The present study demonstrates that TNF-α inhibitors treatment ameliorates CMD in patients with established psoriasis not responding to long-term conventional therapy. These findings suggest that a therapy specifically targeted against inflammation is able to positively affect coronary microvascular function.
Authors: Billie K Alba; Jody L Greaney; Sara B Ferguson; Lacy M Alexander Journal: Am J Physiol Heart Circ Physiol Date: 2017-10-20 Impact factor: 4.733
Authors: Nehal N Mehta; Heather L Teague; William R Swindell; Yvonne Baumer; Nicole L Ward; Xianying Xing; Brooke Baugous; Andrew Johnston; Aditya A Joshi; Joanna Silverman; Drew H Barnes; Liza Wolterink; Rajan P Nair; Philip E Stuart; Martin Playford; John J Voorhees; Mrinal K Sarkar; James T Elder; Katherine Gallagher; Santhi K Ganesh; Johann E Gudjonsson Journal: Sci Rep Date: 2017-10-23 Impact factor: 4.379