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

Abstract

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.