SHORT REPORT
Myocardial function and effects of biologic therapy in
patients with severe psoriasis: a prospective
echocardiographic study
O. Ahlehoff,
1,2,3,
* P.R. Hansen,
3
G.H. Gislason,
3
M. Frydland,
1
L.E. Bryld,
4
H. Elming,
2
G.B.E. Jemec
4
1
Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
2
Department of Cardiology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
3
Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
4
Department of Dermatology, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark
*Correspondence: O. Ahlehoff. E-mail: Ole.Ahlehoff@regionh.dk
Abstract
Background Psoriasis is a chronic inflammatory disease and is associated with cardiovascular events. Little is known
about subclinical myocardial dysfunction and potential changes in myocardial function during anti-inflammatory treat-
ment in these patients. We prospectively studied left ventricular function in patients with severe psoriasis who initiated
biologic therapy.
Methods Between November 1 2013 and May 31 2014 the study subjects underwent physical, laboratory and compre-
hensive echocardiographic examination at baseline and after 3 months of treatment. Pearson correlation coefficients
and Student’s t-test were applied to assess changes in diastolic function (defined as the E/e’ ratio) and global longitudi-
nal strain (GLS).
Results Eighteen patients with severe psoriasis treated with biologic therapy with a mean follow-up of
85.6 18.2 days were included. The patients had a baseline psoriasis area and severity index (PASI) of 12.0 4.1 and
normal left ventricular ejection fraction [(LVEF) 56.3 3.8%], diastolic dysfunction (E/e
0
8.1 2.1) and GLS
(16.8 2.1%). At follow-up, an improvement (baseline vs. follow-up) of PASI (12.0 4.1 vs. 2.7 3.1, P < 0.001), E/e
0
(8.1 2.1 vs. 6.7 1.9, P ≤ 0.001) and GLS (16.8 2.1 vs. 18.3 2.3%, P < 0.001) were recorded. No changes
were demonstrated in LVEF (56.3 3.8 vs. 56.8 3.3%, P = 0.31), body mass index (30.9 5.7 vs. 31.0 5.8 kg/m
2
,
P = 0.90), mean arterial blood pressure (103.1 8.5 vs. 103.7 10.8 mmHg, P = 0.74). Likewise, no changes were
seen in total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, estimated glomerular
filtration rate and glycosylated haemoglobin.
Conclusion In patients with severe psoriasis treatment with biologic therapy was associated with improved PASI and
amelioration of myocardial dysfunction.
Received: 20 January 2015; Accepted: 17 March 2015
Conflicts of interest
This study was supported in part by Region Zealand, Danish Psoriasis Research Foundation, Axel Muusfeldt Foundation
and by an unrestricted clinical research scholarship from the Novo Nordisk Foundation. Dr. Ahlehoff serve as consultant
to AbbVie, Pfizer, Merck, Sharp and Dohme (MSD) and Janssen Pharmaceuticals.
Funding sources
None disclosed.
Introduction
Psoriasis is a common chronic inflammatory disease and is asso-
ciated with increased risk cardiovascular disease possibly because
of overlapping risk factors and shared immune-inflammatory
mechanisms.
1–3
Inflammation plays an important role in athero-
genesis and targeted anti-inflammatory treatment holds promise
for the prevention of cardiovascular disease.
4,5
Therefore, con-
siderable attention has been given to the potential impact of
anti-inflammatory therapy on risk of cardiovascular events in
these patients.
6–9
Speckle-tracking echocardiography, including
evaluation of left ventricular systolic deformation, i.e. global lon-
gitudinal strain (GLS), has emerged as an echocardiographic
© 2015 European Academy of Dermatology and Venereology JEADV 2015
DOI: 10.1111/jdv.13152 JEADV