Is chronic inflammation a risk factor for perioperative myocardial injury or heart failure in pancreatic surgery patients?

BACKGROUND

Chronic inflammation is associated with cardiovascular disease. Whether cardiac risk is increased in surgical patients with chronic inflammation is unknown. We hypothesised that preoperative interleukin 6 (IL-6) is associated with postoperative biomarker release indicative of myocardial injury and heart failure.

METHODS

In this prospective cohort study in pancreatic surgery patients, concentrations of IL-6, high-sensitive cardiac troponin-T (hs-cTnT), growth differentiation factor 15 (GDF-15), and N-terminal pro B-type natriuretic peptide (NT-proBNP) were assessed before surgery and 4, 12, 24, and 48 h after surgery. The primary outcome was perioperative myocardial injury (PMI), defined as an absolute hs-cTnT increase ≥14 pg ml-1. Secondary outcomes were postoperative concentrations of GDF-15 and NT-proBNP. We used the χ2 test and generalised linear mixed effects models for analyses.

RESULTS

Of 88 patients, 24 (27%) had high preoperative IL-6 (>7 pg ml-1). PMI occurred in two (8.3%) and eight (12.5%) patients with high and normal concentrations, respectively (P=0.86). Patients with high IL-6 had higher preoperative concentrations of hs-cTnT (11.0 [inter-quartile range 7.0-15.0] vs 8.0 [5.0-11.0] pg ml-1, P=0.01), GDF-15 (1924.5 [1403.8-2797.5] vs 1445.0 pg ml-1 [1006.5-1905.3] pg ml-1, P=0.021) and NT-proBNP (279.5 [128.8-569.0] vs 116.5 [65.1-226.5] pg ml-1, P=0.012). All biomarkers increased after surgery (all P<0.05), yet this increase was similar among patients with high or normal preoperative IL-6 concentrations.

CONCLUSIONS

Preoperative inflammation was not associated with PMI or postoperative biomarkers of heart failure after pancreatic surgery. However, patients with high IL-6 concentrations had higher preoperative concentrations of cardiac biomarkers, suggesting the presence of subclinical cardiovascular disease.

CLINICAL TRIAL REGISTRATION: NCT03460938.