title: Subclinical cardiovascular disease and it's improvement after long-term TNF-α inhibitor therapy in severe psoriatic patients.
abstract: BACKGROUND
  There are conflicting data on the occurrence of subclinical myocardial dysfunction in psoriatic patients and on the impact of long-term tumour necrosis factor-alpha (TNF-α) inhibitor therapy on cardiac function.
  
  
  OBJECTIVE
  In this study, we explored whether there are any signs of subclinical cardiovascular disease (echocardiographic abnormalities) in severe psoriatic patients without clinically overt heart disease. As a second objective, the influence of long-term treatment with TNF-α inhibitors on the ventricular functions of psoriatic patients was also investigated.
  
  
  METHODS
  Clinical and echocardiographic data from 44 psoriatic patients and 45 age- and sex-matched controls were processed. As a first step, the echocardiographic parameters of psoriatic patients obtained before anti-TNF-α treatment were compared with controls. As a second step, to detect the effect of long-term anti-TNF-α treatment on echocardiographic parameters, data of patients before and after therapy were analysed.
  
  
  RESULTS
  The right ventricular Tei index was higher (P < 0.001), whereas the tricuspid annular plane systolic excursion (TAPSE) and right ventricular free wall peak systolic velocity were lower (P < 0.001 and P < 0.0001, respectively) in the psoriatic patients than in the controls. Following treatment with TNF-α inhibitors, TAPSE and right ventricular free wall peak systolic velocity significantly improved (P < 0.0001 for both parameters). The Tei index of both ventricles improved during biological therapy; however, this change did not reach statistical significance.
  
  
  CONCLUSIONS
  Patients with severe psoriasis exhibit signs of subclinical cardiovascular disease compared to control, and prolonged anti-TNF-α therapy has a potentially beneficial effect on these signs.
authors.affiliation: Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: E
authors.initials: E
authors.lastname: Herédi
authors.affiliation: Division of Clinical Immunology, Institute of Internal Medicine, Clinical Centre, University of Debrecen, Debrecen, Hungary.
authors.forename: J
authors.initials: J
authors.lastname: Végh
authors.affiliation: Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Pogácsás
authors.affiliation: Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: K
authors.initials: K
authors.lastname: Gáspár
authors.affiliation: Department of Nuclear Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: J
authors.initials: J
authors.lastname: Varga
authors.affiliation: Department of Rheumatology, Kenézy Gyula Hospital, Debrecen, Hungary.
authors.forename: G
authors.initials: G
authors.lastname: Kincse
authors.affiliation: Division of Clinical Immunology, Institute of Internal Medicine, Clinical Centre, University of Debrecen, Debrecen, Hungary.
authors.forename: M
authors.initials: M
authors.lastname: Zeher
authors.affiliation: Division of Dermatological Allergology, Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Szegedi
authors.affiliation: Division of Clinical Immunology, Institute of Internal Medicine, Clinical Centre, University of Debrecen, Debrecen, Hungary.|Department of Rheumatology, Kenézy Gyula Hospital, Debrecen, Hungary.
authors.forename: J
authors.initials: J
authors.lastname: Gaál
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D003879:Dermatologic Agents / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000150:complications / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha