Changes in biventricular myocardial function after six months of ixekizumab therapy in patients with psoriatic arthritis: a prospective speckle-tracking echocardiographic study.

Abstract

To evaluate longitudinal changes in conventional and speckle-tracking echocardiographic indices in patients with psoriatic arthritis (PsA) who achieved a disease activity index for psoriatic arthritis (DAPSA)-defined clinical response during ixekizumab therapy.In this prospective single-centre observational cohort, 21 adults with PsA underwent clinical, laboratory and transthoracic echocardiographic assessment before ixekizumab initiation and after 6 months of treatment. The principal echocardiographic outcome was the within-patient change in absolute left vetricle global longitudinal strain (LV GLS) between baseline and 6 months. Secondary echocardiographic outcomes included right ventricle (RV) GLS, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (RV S') and tricuspid E to E' ratio (E/E'), while clinical secondary outcomes included DAPSA, body surface area (BSA), minimal disease activity (MDA), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Mean age was 49.6 ± 11.6 years, 57.1% were male and 11 patients (52.4%) were biologic-naïve. MDA was achieved by 17 patients (81.0%). DAPSA decreased from 28.9 ± 4.3 to 7.7 ± 4.2, accompanied by reductions in CRP and ESR (all p < 0.001). Absolute LV GLS increased from 18.5 ± 1.3% to 20.5 ± 1.9% (mean change 2.0%, 95% CI 1.49-2.51; p < 0.001), while absolute RV GLS increased from 21.5 ± 3.3% to 25.8 ± 4.2% (mean change 4.29%, 95% CI 3.37-5.20; p < 0.001). LVEF, TAPSE, RV S' and E/E' also improved significantly. Although DAPSA reduction correlated with increased LVEF, while BSA reduction with increased LV GLS and TAPSE, these associations were exploratory and should be interpreted cautiously. Among patients with PsA who achieved clinical response to ixekizumab, 6 months of treatment was accompanied by improvements in left- and right-ventricular functional indices. Because the cohort was small, responder-enriched and lacked a comparator group, these findings should be considered hypothesis-generating and require confirmation in larger controlled studies.