Biomarkers of inflammation and left ventricular remodelling in psoriasis patients treated with infliximab

Objective: Psoriasis is an immune mediated disorder associated with T cell activation and cardiovascular disease (CVD). We explored the association of inflammation with left ventricular (LV) remodelling in psoriasis patients receiving treatment with the tumour necrosis factor-alpha (TNF-alpha) blocker infliximab. Methods: Psoriasis patients (n = 47, age 47 +/- 14 years, 66% men) and 99 control subjects without psoriasis (age 47 +/- 11 years, 72% men) were examined by echocardiography in a cross-sectional study. LV remodelling was assessed by LV mass index for height in the allometric power of 2.7. Serum concentrations of C-reactive protein (CRP), serum amyloid A (SAA), neopterin, kynurenine:tryptophan ratio (KTR) and the pyridoxic acid ratio (PAr) index were measured. Results: Serum concentration of neopterin (p = .007) was higher in psoriasis patients, while the other inflammatory biomarkers had similar levels. LV mass index was lower in patients than controls (35.6 +/- 9.6 g/m(2.7) vs. 40.3 +/- 9.8 g/m(2.7), p = .008). In the total study population, serum SAA (beta = 0.18, p = .02), KTR (beta = 0.20, p = .02) and the PAr index (beta = 0.26, p = .002) were all associated with higher LV mass index independent of age, sex, body mass index, hypertension, smoking, renal function and psoriasis. Also in psoriasis patients, higher SAA level (beta = 0.34, p = .02), KTR (beta = 0.32, p = .02) and the PAr index (beta = 0.29, p = .05) were associated with higher LV mass index independent of body mass index, hypertension and diabetes. Conclusion: Higher levels of the inflammatory biomarkers SAA, KTR and the PAr index were associated with greater LV mass index in psoriasis patients, indicating a role of chronic inflammation in LV remodelling evident even during treatment with TNF-alpha blockers.

Automated summary

This study explored the association of inflammation with left ventricular remodelling in psoriasis patients receiving treatment with TNF-alpha blocker infliximab. The results showed that higher levels of inflammatory biomarkers were associated with greater LV mass index in psoriasis patients, indicating a role of chronic inflammation in LV remodelling.