Differential effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Ikonomidis ◽  
D Vlastos ◽  
G Kostelli ◽  
K Kourea ◽  
K Katogiannis ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Platelet Activation ◽  
Vascular Function ◽  
Coronary Flow ◽  
Arterial Compliance ◽  
Public Institution ◽  
Protein Carbonyls ◽  
Funding Source ◽  
Flow Reserve ◽  
Chronic Study

Abstract   Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product. Methods We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomised into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study. Results Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p<0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: −55% vs −2.4%), FMD (+55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs −0.5%), GLS (+6% vs +1%), GWW (−19% vs +0.5%), MDA (−19% vs 1%), and TxB2 (−12% vs 4%) (p<0.05 for all comparisons). Conclusions HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than tobacco Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Hellenic Association of Lipidiology, Atherosclerosis and Vascular disease

scholarly journals Effects of heat-not-burn compared to combustible cigarettes on coronary flow, myocardial work index and vascular function

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Ikonomidis ◽  
K Katogiannis ◽  
D Vlastos ◽  
G Kostelli ◽  
K Kourea ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Platelet Activation ◽  
Vascular Function ◽  
Coronary Flow ◽  
Arterial Compliance ◽  
Chronic Phase ◽  
Protein Carbonyls ◽  
Flow Reserve ◽  
Work Index ◽  
Chronic Study

Abstract Funding Acknowledgements Type of funding sources: None. Aim/Introduction: Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product. Purpose We compare the effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function, platelet activation and oxidative stress. Methods We compared the effects of HNBC to those of tobacco cigarette (TCig), on arterial stiffness, oxidative stress, and platelet activation, acutely and after 1 month of switching to HNBC, as well as on endothelial, myocardial, and coronary function after 1 month of switching to HNBC. In the acute study, 50 smokers were randomized into smoking a single Tcig or an HNBC and after 60 minutes were crossed over to the alternate smoking (HNBC or Tcig). For the chronic phase, 75 smokers were examined. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. Pulse wave velocity (PWV) and biomarkers [malondialdehyde (MDA), protein carbonyls (PC), and thromboxane B2 (TXB2)] were assessed in the acute and chronic study. Myocardial deformation [global longitundinal strain (GLS), myocardial work index (GWI) and wasted myocardial work (GWW)], coronary flow reserve (CFR) by Doppler echocardiography, total arterial compliance (TAC), and flow-mediated dilation (FMD) were additionally assessed in the chronic study. Results Compared to baseline, TCig smoking acutely increased exhaled CO, PWV, MDA, and TxB2 (p < 0.05), while no changes were observed after HNBC. Compared to resuming Tcig smoking, switching to HNBC for 1 month improved CO (mean change: -55% vs -2.4%), FMD ( +55% vs +15%), CFR (+46% vs +4%), TAC (+9% vs -0.5%), GLS (+6% vs +1%), GWW (-19% vs +0.5%), MDA (-19% vs 1 %), and TxB2 (-12% vs 4%) (p < 0.05 for all comparisons). Conclusions HNBCs exert a less detrimental effect on vascular, cardiac and platelet function than combustible tobacco.

scholarly journals Differential effects of heat-not-burn and conventional cigarettes on coronary flow, myocardial and vascular function

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ignatios Ikonomidis ◽  
Dimitrios Vlastos ◽  
Gavriela Kostelli ◽  
Kallirhoe Kourea ◽  
Konstantinos Katogiannis ◽  
...  
Keyword(s):  
Vascular Function ◽  
Coronary Flow ◽  
Arterial Compliance ◽  
Global Longitudinal Strain ◽  
Chronic Phase ◽  
Flow Reserve ◽  
Work Index ◽  
Total Arterial Compliance ◽  
Before And After ◽  
Chronic Study

AbstractWe compared the effects of Heat-not-Burn cigarette (HNBC) to those of tobacco cigarette (Tcig), on myocardial, coronary and arterial function as well as on oxidative stress and platelet activation in 75 smokers. In the acute study, 50 smokers were randomised into smoking a single Tcig or a HNBC and after 60 min were crossed-over to the alternate smoking. For chronic phase, 50 smokers were switched to HNBC and were compared with an external group of 25 Tcig smokers before and after 1 month. Exhaled carbon monoxide (CO), pulse wave velocity (PWV), malondialdehyde (MDA) and thromboxane B2 (TxB2) were assessed in the acute and chronic study. Global longitudinal strain (GLS), myocardial work index (GWI), wasted myocardial work (GWW), coronary flow reserve (CFR), total arterial compliance (TAC) and flow-mediated dilation (FMD) were assessed in the chronic study. Acute HNBC smoking caused a smaller increase of PWV than Tcig (change 1.1 vs 0.54 m/s, p < 0.05) without change in CO and biomarkers in contrast to Tcig. Compared to Tcig, switching to HNBC for 1-month improved CO, FMD, CFR, TAC, GLS, GWW, MDA, TxB2 (differences 10.42 ppm, 4.3%, 0.98, 1.8 mL/mmHg, 2.35%, 19.72 mmHg%, 0.38 nmol/L and 45 pg/mL respectively, p < 0.05). HNBCs exert a less detrimental effect on vascular and cardiac function than tobacco cigarettes.Trial registration Registered on https://clinicaltrials.gov/ (NCT03452124, 02/03/2018).

scholarly journals The midterm differential effects of heat-not-burn and conventional cigarettes on coronary flow, vascular function and oxidative stress are independent of nicotine levels

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Ikonomidis ◽  
K Katogiannis ◽  
D Vlastos ◽  
G Kostelli ◽  
K Kourea ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Platelet Activation ◽  
Vascular Function ◽  
Coronary Flow ◽  
Smoking Habit ◽  
Control Group ◽  
Blood Levels ◽  
Funding Sources ◽  
Flow Reserve ◽  
And Oxidative Stress

Abstract Introduction Heat-not-burn cigarette (HNBC) constitutes a non-combustible smoke product linked to reduced exposure to carbon monoxide (CO). Methods We compared the effects of HNBC to those of tobacco cigarette (TCig) on endothelial and coronary function as well as on nicotine levels, oxidative stress and platelet activation after 1 month of switching to HNBC. We examined 75 smokers. Of those, 50 were switched to HNBC and 25 continued Tcig for 1 month. At baseline and at 1 month, we assessed a) coronary flow reserve (CFR) by echocardiography b) flow-mediated dilation (FMD) c) Cotinine blood levels, a stable metabolite of nicotine d) malondialdehyde (MDA), a marker of oxidative stress and thromboxane B2 (TXB2), a marker of platelet activation e) the exhaled CO and the number of cigarettes and/or heat stick of HNBC used. Fagerstrom score, a marker of dependence from smoking habit was also calculated. Results Compared to Tcig smoking, switching to HNBC for 1-month improved CO (difference in CO between groups: 10.42 ppm; 95% CI 3.07 to 17.76, p=0.007), FMD (difference in FMD=4.3%; 95% CI: 1.23 to 7.51, p=0.009; and CFR (difference in CFR =0.98; 95% CI: 0.23 to 1.80, p=0.02). MDA and TXB2 concentration significantly decreased in subjects switching to HNBC compared to tobacco smokers (difference MDA=0.38 nmol/L; 95% CI 0.10 to 0.66, p=0.009, 45pg/mL; 95% CI 5.28 to 86.31, p=0.03). None of the aforementioned parameters changed in the control group at 1 month compared to baseline (p&gt;0.05). Cotinine blood levels were similar between the TC cig and HNBC group both at baseline and after one month of use (p&gt;0.05). However, cotinine blood levels at baseline and 1 month correlated with the number cigarettes used at baseline (r=0.45 p=0.04) or the number of heat sticks used at one month (r=0.50, p=0.03) respectively, Baseline Fagerstrom score was also associated with number of heat sticks used at 1 month (r=0.48, p=0.04) and cotinine levels at baseline and at 1 month (p=0.50, p=0.03 and r=0.57, p=0.01 respectively). Conclusions HNBCs exert a less detrimental effect on vascular function platelet activation and oxidative stress than tobacco smoking that is independent of nicotine levels and is linked with the parallel reduction the exhaled of CO. FUNDunding Acknowledgement Type of funding sources: None.

P940Effects of IQOS smoking on vascular function, coronary flow reserve, myocardial deformation and myocardial work index during one month of use

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Ikonomidis ◽  
K Katogiannis ◽  
K Kourea ◽  
G Kostelli ◽  
D Vlastos ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Flow Reserve ◽  
Vascular Function ◽  
Coronary Flow ◽  
Smoking Status ◽  
Myocardial Strain ◽  
Chronic Phase ◽  
Myocardial Deformation ◽  
Flow Reserve ◽  
Work Index

Abstract Background IQOS smoking (heat-no burn smoke product) is proposed to reduce harm compared to conventional smoking. We examined its effects on vascular function, myocardial deformation and ventricular arterial coupling. Methods Thirty-seven current smokers (mean age 48±5 years, >20 cigarettes /day) without cardiovascular disease and 20 healthy subjects with similar age sex and risk factors participated in the study. All subjects were instructed to smoke only IQOS for one month. Measurements were performed at baseline and 1 month after smoking IQOS. we measured a) the aortic PWV (PWV) and central aortic systole blood pressure (SBPc) by Complior; b) the exhaled CO level (parts per million-ppm) as a smoking status marker; and c) brachial systolic (SBP)and diastolic (DBP) blood pressure and heart rate (HR) a) flow mediated dilation (FMD) of the brachial artery b) coronary flow reserve (CFR) after adenosine infusion by Doppler echocardiography and c) global longitundinal strain (GLS) peak twisting and untwisting velocity and myocardial work index derived by pressure –myocardial strain loops by speckle tracking imaging PWV to GLS ratio was also used as a marker of ventricular arterial coupling Results At baseline exhaled CO, PWV, SBPc, FMD, PWV/GLS ratio, myocardial work index and peak untwisting velocity were higher and CFR was lower in smokers compared to controls (14.9±7 vs. 4.2±1 ppm, p<0.001, 8.7±1.4 vs 10.0±1.6 m/s, p<0.05; 118±16 vs 110±7 mmHg p<0.001, 6.9±2 vs 9.5±2% p<0.001, −0.61±0.21 vs. −0.45±0.11 m/sec%, p<0.001, 1926±284 vs 1826±300 mmHg% p=0.04, −122±36 vs −95±25 deg/sec, p=0.02, 2.5±0.9 vs. 3.1±0.8 p=0.001 respectively). In the chronic phase we observed a significant improvement of FMD, CFR, GLS, PWV/GLS, myocardial work index and peak untwisting velocity compared to baseline (12±2% vs. 6.9±2%, p=0.03; 3.2±0.6 vs. 2.5±0.9 p=0.001; −19.3±2.2% vs. −21.1±2.8%, p=0.001; −0.61±0.21 vs. −0.47±0.12 m/sec% p=0.03; 1926±284 vs 1830±343 mmHg% p=0.03, −122±36 vs −105±25 deg/sec, p=0.03, respectively) in parallel with reduction of the exhaled CO (14.9±7 vs. 6±4.9 ppm, p<0.001). HR remained unchanged throughout the study and there was a borderline reduction of central aortic systolic blood pressure (118±16 vs. 114±19 mmHg, p=0.048). Conclusions Replacement of conventional cigarettes with IQOS results in improved LV longitundinal myocardial deformation, LV untwisting and reduced LV myocardial work index possibly linked to the concomitant improvement of aortic elasticity, endothelial and coronary microcirculatory function and ventricular-arterial coupling within 1 month.

Gender-dependent regulation of FABP4 and leptin according to atrial fibrillation burden

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.N Lopez-Canoa ◽  
M Couselo-Seijas ◽  
A Baluja ◽  
L Gonzalez-Melchor ◽  
A Rozados ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Atrial Fibrillation ◽  
Sex Differences ◽  
Catheter Ablation ◽  
Previous History ◽  
Correlation Coefficients ◽  
Suspected Coronary Artery Disease ◽  
Public Institution ◽  
Funding Source ◽  
Af Recurrence

Abstract Aims Adiposity plays a key role in the pathogenesis of atrial fibrillation (AF). Its associated proteins are differentially released between male and female. FABP4 and leptin are mediators in adipose tissue-inflammatory effects. Our aim was to study their gender differential behavior on mechanisms associated with AF progression. Methods and results Two independent cohorts were analyzed: A) patients referred for AF catheter ablation (n=217) and patients with suspected coronary artery disease referred for a CT scan (without previous history of AF) (n=105). Protein levels were determined by multiplex fluorometric immunoassay. Gene mRNA expression was analyzed by real time polymerase chain reaction. Correlation between biomarkers was explored with heatmaps and Kendall correlation coefficients. Logistic regression and random forest model determined the best predictors of AF recurrence after catheter ablation. Our results showed: 1) a distinctive profile according to gender, with an increment of FABP4 levels in women (20±14, 29±18 and 31±17 ng/mL; p=0.007) and a decrease of leptin levels in men (22±15, 13±16 and 13±11 ng/mL; p=0.001) among control, paroxysmal and persistent AF groups, respectively; 2) sex differences regarding inflammatory profile, oxidative stress and autonomic indirect markers in AF; 3) a prominent role of adipokines to discriminate AF recurrence after ablation. In persistent AF, FABP4 was the best predictor (LR coefficient 1.067, 95% CI 1–1.14, p=0.046). Conclusion The major finding of the present study is the sex differences of FABP4 and leptin according to AF burden. The relationship of these adipokines with oxidative stress, inflammatory and autonomic indirect markers might explain part of the mechanisms underlying the AF perpetuation. Adipokines regarding Gender & AF burden Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Institute of Health Carlos III

Impact of chronic use of heat-not-burn cigarettes on oxidative stress, endothelial dysfunction and platelet activation: the SUR-VAPES Chronic Study

Thorax ◽  
2021 ◽  
pp. thoraxjnl-2020-215900
Author(s):  
Lorenzo Loffredo ◽  
Roberto Carnevale ◽  
Simona Battaglia ◽  
Roberta Marti ◽  
Stefano Pizzolo ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Endothelial Dysfunction ◽  
Observational Study ◽  
Endothelial Function ◽  
Platelet Activation ◽  
Morbidity And Mortality ◽  
Chronic Study ◽  
Chronic Use

Tobacco habit still represents the leading preventable cause of morbidity and mortality worldwide. Heat-not-burn cigarettes (HNBCs) are considered as an alternative to traditional combustion cigarettes (TCCs) due to the lack of combustion and the absence of combustion-related specific toxicants. The aim of this observational study was to assess the effect of HNBC on endothelial function, oxidative stress and platelet activation in chronic adult TCC smokers and HNBC users. The results showed that both HNBC and TCC display an adverse phenotype in terms of endothelial function, oxidative stress and platelet activation. Future randomised studies are strongly warranted to confirm these data.

Evaluation of vascular function by modern non-invasive methods

2012 ◽  
Vol 153 (48) ◽  
pp. 1887-1895 ◽  
Author(s):  
Attila Nemes ◽  
Tamás Forster
Keyword(s):  
Early Detection ◽  
Coronary Flow Reserve ◽  
Vascular Injury ◽  
Vascular Function ◽  
Coronary Flow ◽  
Morphological Changes ◽  
Non Invasive ◽  
Flow Reserve ◽  
Clinical Methods ◽  
Myocardial Flow

Vascular functional alterations frequently precede morphological changes and, therefore, their recognition may theoretically improve early detection of vascular injury. The aim of this review is to demonstrate recently available non-invasive clinical methods including vascular stiffness examinations, flow-mediated vasodilatation, coronary flow reserve and myocardial flow reserve measurements. Orv. Hetil., 2012, 153, 1887–1895.

Coronary flow reserve can explain some of FFR and iFR discrepancies. Results from international, multicenter and prospective trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kovarnik ◽  
H Matsuo ◽  
S Jerabek ◽  
Y Kawase ◽  
H Omori ◽  
...  
Keyword(s):  
Coronary Flow Reserve ◽  
Coronary Flow ◽  
Prospective Trial ◽  
Funding Source ◽  
Fractional Flow ◽  
Prospective Data ◽  
National Budget ◽  
Flow Reserve ◽  
Health Research Council ◽  
Public Grant

Abstract Background The trial collected prospective data from physiology measurements of borderline lesions in five Czech, one Japan and one Argentinian cathlabs. The main purposes were to analyze diagnostic agreement between FFR (fractional flow reserve) and iFR (instantaneous wave free ratio) examinations and to find possible explanations for discrepant results. Methods FFR and iFR examinations were analyzed using Philips-Volcano console and coronary flow reserve (CFR) was analyzed by using Combomap machine Philips-Volcano. Hyperemia for FFR and CFR measurements was induced by intracoronary administration of adenosine. We used CFR as a truth for comparison between FFR and iFR, because CFR has higher impact on patients prognosis than pressures indices. Results Data were collected from February 2016 to June 2019 and the database includes 1.789 examinations from 1.492 patients (282 of them, 15.8%, with ACS). CFR were measured in 343 lesions in 293 patients. (ACS 31.2%). Overall correlation between FFR and iFR is high (R=0.86 p&lt;0.0001). The FFR/iFR discrepancy occurred in 84 measurements (24.5%), more frequently it was FFRp (positive) / iFRn (negative) type of discrepancy (65, 18.9%) compare to FFRn/iFRp (19, 5.5%) one. There was no difference in occurrence of FFR/iFR discrepancy in stable patients and ACS ones (25.1%vs. 22.4%, p=0.59). The CFR correlated better with iFR than with FFR (R=0.56, p&lt;0.0001 vs. R= 0.36, p&lt;0.0001) (see table). In lesions with FFRp/iFRn type of discrepancy we found substantially higher CFR value compared to FFR/iFR agreement group (2.4±0.7 vs. 1.5±0.5, p&lt;0.0001). Unlike to FFRn/iFRp discrepancy, where CFR value was similar with agreement group (1.4±0.1 vs. 1.5±0.1, p=0.25) Conclusion The FFR/iFR discrepancy occurred in almost one quarter of examinations. Correlation between CFR and iFR is better than between CFR and FFR. High flow is probably one of the main reason for FFRp/iFRn type of discrepancy. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council

Coronary microvascular dysfunction results in impaired coronary flow reserve and altered oxygen balance in a swine model of INOCA with multiple risk factors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Sorop ◽  
J Van De Wouw ◽  
R.W.A Van Drie ◽  
J.A Joles ◽  
M.C Verhaar ◽  
...  
Keyword(s):  
Oxygen Delivery ◽  
Coronary Flow ◽  
Microvascular Dysfunction ◽  
Coronary Microvascular Dysfunction ◽  
Swine Model ◽  
Funding Source ◽  
Oxygen Balance ◽  
Flow Reserve ◽  
No Bioavailability ◽  
And Function

Abstract Introduction Comorbidities of ischemic heart disease, including diabetes mellitus (DM), hypercholesterolemia and chronic kidney disease (CKD), are associated with coronary microvascular dysfunction (CMD) and may contribute to myocardial “Ischemia and No Obstructive Coronary Artery disease” (INOCA). Purpose We studied myocardial perfusion and oxygen delivery using a novel swine model with multiple comorbidities. Methods DM (streptozotocin), HFD (high fat diet) and CKD (renal embolization), were induced in 12 female swine (DM+HFD+CKD), while 12 healthy female swine on a normal diet served as controls (CON). After 6 months, in the absence of coronary atherosclerosis, myocardial perfusion and function were studied at rest and during treadmill exercise. Results DM+HFD+CKD animals showed hyperglycemia, hypercholesterolemia and impaired kidney function. During exercise, DM+HFD+CKD demonstrated impaired myocardial blood flow and oxygen delivery, necessitating higher myocardial oxygen extraction (despite reduced capillary density), resulting in lower coronary venous oxygen levels, (Fig. 1). These perturbations were associated with lower myocardial efficiency, requiring higher oxygen consumption for a given level of myocardial work (Fig. 1), lower myocardial lactate consumption, stroke volume and LVdP/dtmax, suggestive of myocardial ischemia and dysfunction. Furthermore DM+HFD+CKD showed a reduction in adenosine-recruitable coronary flow reserve (2.69±0.26 vs 3.64±0.2 in CON, p&lt;0.05), which was exclusively the result of an increase in basal coronary blood flow, while maximal coronary flow per gram of myocardium was maintained. The latter was consistent with the unchanged arteriolar wall/lumen ratio, arteriolar density and peri-arteriolar collagen content. eNOS blockade indicated loss of NO bioavailability in DM+HFD+CKD swine in vivo (Fig. 1), which was supported by blunted endothelium-dependent vasodilation to bradykinin in isolated small arteries. These findings suggest that changes in coronary microvascular function rather than structure contributed to the perturbations in myocardial oxygen delivery. Conclusion Common comorbidities result in CMD and impaired NO bioavailability rather than structural alterations in the microvasculature in swine, in the absence of appreciable atherosclerosis. These alterations are severe enough to produce perturbations in myocardial oxygen balance and coronary metabolism and function, particularly during exercise, resembling key features of INOCA. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): This study was supported by grants from the European Commission FP7-Health-2010 grant MEDIA-261409, the Netherlands CardioVascular Research Initiative: an initiative with support of the Dutch Heart Foundation [CVON2014-11 (RECONNECT)].

P4445Effects of interleukin 17A inhibition on myocardial deformation and vascular function in psoriasis:one year follow-up

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Ikonomidis ◽  
G Makavos ◽  
J Thymis ◽  
P Rafouli-Stergiou ◽  
H Triantafyllidi ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Strain Rate ◽  
Vascular Function ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Post Treatment ◽  
Myocardial Deformation ◽  
Lv Function ◽  
Flow Reserve ◽  
Markers Of Oxidative Stress

Abstract Background Interleukin (IL)-17A activity is implicated in the clinical course of psoriasis. We investigated the effects of IL-17A inhibition on vascular and left ventricular (LV) function in psoriasis patients. Methods One hundred psoriasis patients received either an anti-IL-17A agent (secukinumab n=50), or cyclosporine treatment (n=50). At baseline and after 4 and 12 months of treatment, we measured (1) LV global longitudinal strain (GLS), strain rate (GLSR), strain rate at early diastole (GLSRE), twisting (LVtwist), (2) coronary flow reserve (CFR), (3) pulse wave velocity (PWV), (4) malondialdehyde (MDA) and protein carbonyl (PC) as markers of oxidative stress, (5) psoriasis severity and extent assessed by Psoriasis Area and Severity Index (PASI). Results Compared to treatment with cyclosporine, anti IL-17A treatment resulted in greater improvement in GLS (GLS: −16.7±3 at baseline vs −18.3±2.8 at 4 months vs −19±3 at 12 months post treatment with anti-IL-17 respectively, p=0.02, GLS: −16.8±2.9 at baseline vs −17.2±2.7 at 4 months vs −17.1±2.9 at 12 months post treatment with cyclosporine respectively, p=0.2), GLSR (−0.9±0.3 at baseline vs −1.08±0.3 at 4 months vs −1.11±0.2 at 12 months post treatment with anti-IL-17 respectively, p=0.02, −0.9±0.2 at baseline vs −0.95±0.2 at 4 months vs −0.96±0.2 at 12 months post treatment with cyclosporine respectively, p=0.5) GLSRE and LV twist (13.7±5.1 at baseline vs 18.1±6 at 4 months vs 17.8±5.6 at 12 months post treatment with anti-IL-17 respectively, p=0.001, 13±5.3 at baseline vs 13.8±5.6 at 4 months vs 15.5±5.3 at 12 months post treatment with cyclosporine respectively, p=0.6).Treatment with anti-IL-17A also resulted in greater improvement of CFR compared to cyclosporine treatment (2.6±0.3 at baseline vs 3±0.3 at 4 months vs 3.1±0.3 at 12 months post treatment with anti-IL-17 respectively, p=0.01, 2.7±0.4 at baseline vs 2.8±0.3 at 4 months vs 2.7±0.3 at 12 months post treatment with cyclosporine respectively, p=0.5) and PWV decreased after treatment with anti-IL-17 (10.2±1.8 at baseline vs 9.3±1.5 at 4 months vs 9.7±1.8 at 12 months post treatment with anti-IL-17 respectively, p=0.04, whereas higher values of PWV were observed after cyclosporine treatment (9.7±1.9 at baseline vs 10.8±1.7 at 4 months vs 11.2±2 at 12 months post treatment with cyclosporine respectively, p=0.02). PASI score was similarly improved after treatment with either anti-IL-17A or cyclosporine. Markers of oxidative stress were reduced after treatment with anti-IL-17A, in contrast to elevation of oxidative stress markers after treatment with cyclosporine. Changes of myocardial deformation markers and CFR after treatment with anti-IL-17A correlated with concomitant reduction of oxidative stress. Conclusions In psoriasis patients, inhibition of IL-17A results in a greater improvement of vascular and myocardial function compared with cyclosporine treatment.

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