Original Article
Differences in Biomarkers Pattern Between Severe Isolated Right and Left Ventricular Dysfunction After Cardiac Surgery

https://doi.org/10.1053/j.jvca.2019.07.128Get rights and content

Objective

To find out if there are any differences in biomarkers between severe isolated right ventricular (RV) dysfunction and severe isolated left ventricular (LV) dysfunction after cardiac surgery using cardiopulmonary bypass.

Design

Observational study.

Setting

Teaching hospital.

Participants

A total of 46 patients who had severe isolated RV or LV dysfunction after cardiac surgery.

Intervention

The authors collected perioperative clinical and biomarker data.

Measurements and Main Results

Severe isolated RV dysfunction patients (n = 20) had higher postoperative direct bilirubin (p = 0.030), total bilirubin (p = 0.044), glucose (p = 0.011), and international normalized ratio (INR) (p = 0.050) by repeated measure analysis of variance when compared with patients with severe isolated LV dysfunction (n = 26). The RV group also showed lower preoperative alanine transferase (19.3 ± 1.5 v 32.7 ± 4.2, p = 0.001), higher 4-hour INR (1.5 ± 0.3 v 1.4 ± 0.2, p = 0.008), and higher 48-hour INR (1.8 ± 0.4 v 1.4 ± 0.1, p < 0.001). None in the LV group died, whereas 4 patients in the RV group died (all of them had preoperative atrial fibrillation and underwent double valve replacement surgery).

Conclusion

The authors observed biomarkers differences between severe isolated RV dysfunction and severe isolated RV dysfunction.

Section snippets

Methods

All patients with severe isolated RV or LV dysfunction after CPB from January 2016 to September 2018 signed a consent allowing for scientific data management and were included in this study. Ethical Committee approval for this case series that described the baseline characteristics, perioperative biomarker release, and complications of these patients was waived according to Italian law. Patients younger than 18 years old and those who had biventricular dysfunction (or no ventricular

Statistical Analysis

All continuous variables were presented as mean ± standard deviation and analyzed by Student's t test or Mann–Whitney U test according to the results of the quantile-quantile plot. Categorical variables were expressed as actual numbers and percentages, and compared using Chi-square or Fisher's exact test. A p value of less than 0.05 was considered as a statistical significance. Changes of biomarkers over time were compared using repeated measures ANOVA. The levels of biomarkers at each time

Results

Out of the 3,418 patients undergoing surgery in the study period, 46 patients were identified with severe isolated RV (n = 20) or LV (n = 26) dysfunction. The baseline differences between patients of RV and LV groups are highlighted in Tables 1 and 2. The patients in the RV group were older (74.6 ± 7.8 v 65.0 ± 11.5 years old, p = 0.003), mainly women (50.0% v 7.7%, p = 0.002), had more baseline atrial fibrillation (60.0% v 26.9%, p = 0.026), and were more frequently on oral anticoagulants

Discussion

The authors identified a highly selected population of patients with severe isolated RV or LV dysfunction and found significantly higher bilirubin (total and direct), INR, and glucose values in the RV group. Patients who developed severe isolated RV failure were at greater risk of death than patients with severe isolated LV failure (interestingly, none of the patients with severe isolated LV dysfunction died).

In patients with cardiac failure, the interaction between heart and liver is well

Acknowledgments

The authors deeply appreciate Giuseppe Giardina's (RN) contribution in data collection.

Funding

This work was supported by a grant from research year of Inje University (No. 20180007).

Declaration of Competing Interest

There is no conflict of interest related to any of the authors.

References (20)

There are more references available in the full text version of this article.

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