Psoriasis severity and the risk of left ventricular remodelling in psoriasis patients treated with infliximab. (14th October 2021)

• Record Type: Journal Article
• Authors: Linde, A; Midtbo, H; Gerdts, E; Kringeland, E; Tveit, K S
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Target Organ Damage/Left Ventricular Hypertrophy; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.2286
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: Psoriasis is an immune mediated skin disorder with a great variation in disease severity. Chronic inflammation predisposes to subclinical cardiac damage like left ventricular (LV) remodelling. However, the association of psoriasis severity with LV remodelling is not known. Purpose: To assess LV remodelling in patients with moderate to severe psoriasis treated with infliximab. Methods: Psoriasis severity was assessed by the Psoriasis Area Severity Index (PASI) before initiation of treatment with the tumour necrosis factor α inhibitor infliximab in 53 patients (age 47±15 years, 30% women, body mass index (BMI) 29.2±5.5 kg/m 2 ). Echocardiography was preformed after a mean follow-up of 4.9±3.8 years and compared to 99 control subjects (age 47±11 years, 28% women, BMI 29.9±3.9 kg/m 2 ). LV remodelling was assessed from LV relative wall thickness and LV mass index by echocardiography. Results: Both psoriasis patients and controls had high prevalence of hypertension (66% vs. 61%, p=0.54) and obesity (34% vs. 33% p=0.94). Psoriasis patients were more likely to be smokers than controls (37% vs. 17%, p=0.005), but other cardiovascular risk factors were similarly distributed. Psoriasis patients had higher LV relative wall thickness (0.38±0.09 vs. 0.34±0.07, p=0.001), but lower LV mass index (36.1±9.6 g/m 2.7 vs. 40.3±9.8 g/m 2.7, p=0.014), compared to controls. Having psoriasis remained associated with higher LV relative wall thickness (β 0.25, p=0.002) and lower LV mass index (β-0.20, p=0.02) in multivariable analyses after adjustment for age, sex, smoking, hypertension and BMI. In psoriasis patients mean PASI decreased from 16.1±11.5 to 0.8±0.8 during infliximab treatment, p<0.001. Higher PASI at start of treatment was associated with a higher LV relative wall thickness at follow-up (Table), but not with higher LV mass index in univariable analyses. After adjusting for sex, age and hypertension, higher PASI at start of treatment (β 0.36, p=0.006) still predicted greater LV relative wall thickness at follow-up in psoriasis patients (Table). Conclusion: Higher psoriasis severity before infliximab treatment predicted presence of adverse LV remodelling after 4.9 years treatment despite nearly complete clinical remission. Funding Acknowledgement: Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Western and South-Eastern Regional Health Authorities of Norway and Hjertefondet, University of Bergen.