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Published on: January 28, 2020
[Cognitive dysfunction and content of inflammatory markers in patients after coronary artery bypass graft]
D A Ovchinnikov1, D D Amosov2, E A Vorobyov3
1Federal Almazov North-West Medical Research Centre, St. Petersburg, Russia; Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia.
Insights
Coronary artery bypass graft (CABG) surgery triggers inflammation, particularly with artificial blood circulation (ABC). This inflammation is linked to cognitive function decline in patients post-CABG, especially those undergoing ABC.
Area of Science:
- Cardiology
- Neuroscience
- Immunology
Background:
- Coronary artery bypass graft (CABG) surgery is a common procedure for ischemic heart disease.
- The use of artificial blood circulation (ABC) during CABG may influence the systemic inflammatory response.
- Cognitive dysfunction is a potential complication following cardiac surgery.
Purpose of the Study:
- To investigate the relationship between inflammatory biomarkers and cognitive function after CABG.
- To compare the inflammatory response and cognitive outcomes between patients undergoing CABG with ABC versus open-heart surgery (OHS).
Main Methods:
- Studied 29 patients post-CABG, divided into ABC (n=18) and OHS (n=11) groups.
- Assessed cognitive function using neurological and neuropsychological testing, including the Montreal scale.
- Measured plasma concentrations of various pro- and anti-inflammatory cytokines before and after surgery using multiplex immunofluorescence assay.
Main Results:
- Both CABG groups showed increased inflammatory cytokine levels post-surgery.
- The ABC group exhibited a significantly higher increase in IL-1RA and other inflammatory markers compared to the OHS group.
- A significant decrease in cognitive function scores was observed in 8/18 patients in the ABC group versus 1/11 in the OHS group.
- Post-surgery cytokine levels (IL-6, IL-8, IP-10, MCP-1) correlated with cognitive decline.
Conclusions:
- CABG induces a systemic inflammatory reaction, more pronounced with ABC.
- CABG using ABC is associated with impaired cognitive function in the first week post-surgery.
- Increased pro-inflammatory cytokine levels are linked to impaired cognitive status after CABG.
Aim:
To study the relationship between the content of inflammatory biomarkers and cognitive function in patients after coronary artery bypass graft (CABG) performed in condition of artificial blood circulation (ABC) or open-heart surgery (OHS).
Material And Methods:
Twenty-nine patients with ischemic heart disease who survived CABG, mean age 62.4±6.2 years, were studied. The ABC group (n=18) and OHS group (n=11) were matched for age and sex. Patients underwent standard clinical examination as well as neurological examination and neuropsychological testing. Concentrations of pro- and anti-inflammatory cytokines (IL-1β, IL-2, IL-4, IL-6, IL-10, IL-12, IL-17, IL-1RA, IFN-γ, IP-10; MCP-1, MIP-1α, MIP-1β, RANTES, TNF) were determined in blood plasma obtained 24 h before and 2h after surgery using multiplex immunofluorescence assay.
Results:
In both groups, an increase in concentrations of IL-6, IL-8, IL-10, IL-12, IP-10, MCP-1, MIP-1β and RANTES was observed at point T1. Concentration of IL-1RA was significantly higher only in the ABC group but not in the OHS group. After CABG, an increase in concentrations of IL-8, IP-10, MIP-1β, IL-1RA was significantly higher in the ABC group. The Montreal scale was the most sensitive test for assessment of cognitive functions in post CABG patients. A significant decrease in scores (>3) was noted in 8 out of 18 patients in the ABC group and in one patient of the OHS group. The correlations between the decrease in cognitive functioning in the 7th day after surgery and plasma cytokine concentration 2 h after surgery were identified for IL-6 (r=0.472; p=0.01); IL-8 (r=0.403; p=0.03); IP-10 (r=0.372; p=0.047); MCP-1 (r=0.470; p=0.01).
Conclusion:
CABG is accompanied by the systemic inflammatory reaction, with the more marked inflammatory effect in patients operated under condition of extracorporeal circulation. CABG with ABC causes an impairment of cognitive functions during the first week in many patients. Impaired cognitive status was associated with the increase in concentrations of proinflammatory cytokines in blood plasma.
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