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Association of anti-heart antibodies and circulating immune complexes in the post-pericardiotomy syndrome
Insights
Post-pericardiotomy syndrome (PPS) after cardiac surgery is linked to anti-heart antibodies (AHA) and circulating immune complexes (CIC). These markers, particularly AHA, correlate with PPS development, especially after heart valve replacement surgery.
Area of Science:
- Cardiology
- Immunology
- Surgical Complications
Background:
- Post-pericardiotomy syndrome (PPS) is a frequent complication following cardiac surgery.
- Understanding the pathogenesis of PPS is crucial for improving patient outcomes.
- Previous studies suggest an immune-mediated component in PPS development.
Purpose of the Study:
- To investigate the role of anti-heart antibodies (AHA), circulating immune complexes (CIC), and anti-viral antibodies (AVA) in the pathogenesis of PPS.
- To correlate the presence and levels of these immune markers with clinical PPS development.
- To identify specific surgical factors associated with PPS and immune marker elevation.
Main Methods:
- Prospective, triple-blind study of 82 long-term cardiac surgery survivors.
- Serial measurement of AHA, CIC, and AVA in patient sera pre- and post-operatively.
- Classification of patients into complete PPS, incomplete PPS, and no PPS groups based on clinical criteria (pericarditis, fever, leukocytosis).
Main Results:
- Clinical PPS occurred in 19.6% of patients, with all positive for AHA.
- Incomplete PPS (29.2%) and no PPS (51.2%) also showed varying levels of AHA and CIC positivity.
- A strong correlation was observed between PPS, positive AHA, and elevated CIC. Heart valve replacement surgery was associated with higher PPS incidence and immune marker elevation. No correlation found with virus serology.
Conclusions:
- Post-operative development of AHA and increased CIC are significantly correlated with the presence and severity of post-pericardiotomy syndrome.
- Immune system activation, specifically involving autoantibodies against heart tissue and immune complex formation, plays a key role in PPS pathogenesis.
- These findings highlight potential targets for diagnostic markers and therapeutic interventions for PPS.
Abstract:
The post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. In order to better understand the pathogenesis of this complication we undertook a prospective, triple blind study of consecutive long term survivors of cardiac surgery. We followed 82 patients and determined anti-heart antibodies (AHA), circulating immune complexes (CIC) and anti-viral antibodies (AVA) on sera pre-operatively and serially post-operatively. According to the clinical features of pericarditis, fever and leucocytosis, patients were divided into three groups: (1) complete PPS with all three symptoms, (2) incomplete PPS with two symptoms and (3) no PPS with one or no symptoms. Clinical PPS was found in 16 patients (19.6%). All of these patients had positive AHA, 12 patients (75%) had increased CIC and five patients (31%) had a four-fold or greater rise in titre to viruses studied. Twenty-four patients (29.2%) had an incomplete PPS. It was accompanied by positive AHA in 17 patients (70.8%), increased CIC in 14 patients (58.3%) and a four-fold rise or greater in virus titre in seven patients (29.2%). No PPS was found in forty-two patients (51.2%). It was accompanied by positive AHA in eight patients (19%), increased CIC in 10 patients (24%) and a four-fold or greater rise in virus titre in 12 patients (28.6%). There was a good correlation between the presence of PPS, AHA, CIC and the type of operation. Heart valve replacement surgery was more frequently complicated by PPS. Development of post-operative AHA and increased CIC were also more frequently found. We found a good correlation between PPS, positive AHA and increased CIC. No correlation was found between PPS and virus serology.