Anti-interleukin therapy for severe asthma and left atrial function improvement: a pilot study

Abstract Background Asthma is an inflammatory disease with systemic consequences. For patients with severe stages of disease, novel treatments targeting IL-5, IL-4, and IL-13 lead to respiratory benefits. We previously demonstrated that patients with severe asthma have similar right ventricular (RV) size and function compared to age and gender match-population but worse left atrial (LA) function. Objective to assess possible beneficial effects of severe asthma treatment on echocardiographic indices compared to baseline. Methods consecutive adult patients with severe asthma and no cardiovascular risk factors referred to our echo lab for a cardiological evaluation before biological treatment were reassessed after 12 months of therapy. They underwent comprehensive cardiac evaluation, including two-dimensional imaging, M-mode analysis, tissue Doppler examinations, and speckle tracking echocardiography (STE) analysis. Kolmogorov-Smirnov test was used to verify normal distribution of variables. Continuous variables were compared using the unpaired t test for normally distributed variables and the nonparametric Mann-Whitney U test for non-normally distributed variables. Results Among the 46 patients who started anti-IL therapy, 11 had an available 12-months follow up (mean age 58±12 years, 54% females). Therapies included: omalizumab, mepolizumab, dupilumab and benralizumab. Table 1 compares echocardiographic parameters at the 2 different time points (T0 vs T12). We confirmed a left ventricular systo-diastolic function within the normal range, without significant variations compared to baseline. Also, RV dimensional and functional indexed remained quite stable or slightly increased compared to T0. Regarding deformation analysis, RV free wall longitudinal strain and global longitudinal strain showed slight non-significant improvement, being already comparable to general healthy population. Interestingly, we demonstrated a significant increase in LA deformation, both in terms of reservoir function (peak atrial longitudinal strain, PALS, 31,1±8,6% vs 35,1±8,3%, p = 0.02) and booster function (peak atrial contraction strain, PACS, -16,8±4,7% vs -20,7±3,8%, p=0.02), but also in LV global longitudinal strain (GLS). Conclusions this pilot study in a small population with severe asthma revealed possible positive effects of anti-interleukin therapy on LA function. The left atrium seems particularly sensible to pro-inflammatory triggers also in other diseases like heart failure, possibly predisposing to atrial fibrillation. Our preliminary data can open to new pathophysiological relationships between asthma and supraventricular tachyarrhythmias.