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CARDIOVASCULAR ANESTHESIA

Myocardial Dysfunction Associated with Proinflammatory Cytokines After Esophageal Resection

Kazuhiro Nakanishi, MD^*, Shinhiro Takeda, MD, PhD^*, Katsuyuki Terajima, MD^*, Teruo Takano, MD, PhD, and Ryo Ogawa, MD, PhD^*

Departments of *Anesthesiology and Medicine, Nippon Medical School, Tokyo, Japan

Address correspondence and reprint requests to Shinhiro Takeda, MD, PhD, Department of Anesthesiology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. Address e-mail to shin/anesth{at}nms.ac.jp

Proinflammatory cytokines have been implicated in mediating myocardial dysfunction associated with major surgery. We investigated the profile of proinflammatory cytokines and the association of cytokine levels with myocardial function after esophagectomy. We studied 12 patients who underwent subtotal esophagectomy. One patient died of multiple organ failure. This patient had the largest interleukin-6 (IL-6) level of all the subjects. IL-6 levels increased from 14.9 ± 8.7 pg/mL to 498.4 ± 294.3 pg/mL (P < 0.05) at 6 h postoperatively. Interleukin-8 (IL-8) levels also significantly increased postoperatively. Right ventricular ejection fraction (RVEF) decreased from 44% ± 1% to 36% ± 2% (P < 0.05) and 37% ± 2% (P < 0.05) at 6 h and 12 h postoperatively. Stroke volume index (SVI) decreased significantly at the end of operation and at 6 h and 12 h postoperatively. The changes of RVEF and SVI showed an independent negative correlation with the IL-6 level (r = -0.70, P < 0.001 and r = -0.62, P < 0.001, respectively). In contrast, the change of RVEF and SVI was not correlated with the IL-8 level. Esophagectomy is associated with transient depression of myocardial function. IL-6 may contribute to this postoperative myocardial dysfunction.

Implications: We examined the association between myocardial function and proinflammatory cytokines after esophagectomy. Interleukin-6 may be the cytokine that most sensitively reflects the postoperative myocardial dysfunction.

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