Why the study?
Recovery from cardiac surgery involves resolving inflammation and remodeling with significant connective tissue turnover, but whether circulating markers return to pre-surgical levels by 3 months remains to be clarified.
Do serum markers of inflammation and remodeling return to baseline levels 3 months after non-emergent cardiac surgery?
Do serum markers of inflammation and remodeling return to baseline levels 3 months after non-emergent cardiac surgery?
Extracellular matrix turnover and partial inflammation persist up to 3 months after non-emergent cardiac surgery, as evidenced by persistently elevated tenascin, YKL-40, and MCP-1 levels.
Novel biomarker trajectories post-cardiac surgery are mapped; hypothesis-generating for prognostic monitoring in recovery.
Background The recovery from cardiac surgery involves resolving inflammation and remodeling with significant connective tissue turnover. Dynamics of smoldering inflammation and injury (white blood cells, platelets, CRP, IL-8, IL-6), vascular inflammation (IL-15, VEGF, RANTES), connective tissue remodeling (tenascin, MMP-9), cardiac injury and remodeling (YKL-40), and vascular remodeling (epiregulin, MCP-1, VEGF) were assessed up to 3 months after cardiac surgery. We hypothesize that at 3 months, studied markers will return to pre-surgical levels. Methods Patients (n = 139) scheduled for non-emergent heart surgery were included, except for patients with pre-existing immunological aberrancies. Blood was collected before surgery(t baseline ), 24 h later(t 24h ) after the first sample, 7 days(t 7d ), and 3 months(t 3m ) after t baseline . Serum markers were measured via multiplex or ELISA. Electronic medical records (EMR) were used to extract demographical, pre-existing conditions and clinical data. Disposition (discharge home, discharge to facility, death, re-admission) was determined at 28 days and 3 months from admission. Results Not all inflammatory markers returned to baseline (CRP↑↑, leukocytosis, thrombocytosis, IL-8↓, IL-6↓). Tenascin and YKL-40 levels remained elevated even at t 3m . YKL-40 serum levels were significantly elevated at t 24h and t 7d while normalized at t 3m . VEGF returned to the baseline, yet MCP-1 remained elevated at 3 months. CCL28 increased at 3 months, while RANTES and IL-15 declined at the same time. Disposition at discharge was determined by serum MMP-9, while YKL-40 correlated with duration of surgery and APACHE II 24h . Conclusions The data demonstrated an ongoing extracellular matrix turnover at 3 months, while acute inflammation and vascular remodeling resolved only partially.
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Liu et al. (2022) studied this question.
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