Anti-heart antibodies in postpericardiotomy syndrome: cause or epiphenomenon? A prospective, longitudinal pilot study.

OBJECTIVES

To assess the role of anti-heart antibodies (AHA) in postpericardiotomy syndrome (PPS) and the timing of their appearance in relation to the initial manifestations of PPS.

DESIGN AND SUBJECTS

Twenty patients who were scheduled to undergo elective coronary artery bypass grafting (CABG) were enrolled in a prospective, longitudinal pilot study.

METHODS

Serum was sampled for AHA on the day prior to surgery and at regular intervalsfollowing surgery in all patients. In those who developed PPS, the serum AHA was determined on the day that typical clinical manifestations of PPS appeared and at regular intervals following the onset of PPS.

RESULTS

All patients were negative for AHA on the day precedingsurgery. Three(15%) patients developed PPS. Their sera were negative for AHA on the day they were diagnosed as sufferingfrom PPS and the sera became positive for AHA within 14 days from the time of diagnosis. The intensity of immunofluorescence decreased markedly 30 days afterwards and AHA had disappeared within 90days after diagnosis of PPS. The other 17 (85%) patients were negative for AHA prior to surgery and remained so during the six-month postoperative follow-up period.

CONCLUSION

The findings of this study suggest that serum AHA may not play a causal role inthe pathogenesis of PPS, but may rather be an epiphenomenon, reflecting an immune response to pericardial and/or myocardial injury.