Pre-operative interleukin-6 levels and pronounced postoperative inflammatory response are associated to INTERMACS profile before left ventricular assist

Purpose. The Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) classification characterizes different clinical profiles of patients with end-stage heart failure (ESHF) undergoing MCS, which are associated with different postoperative risk. Activation of pro-inflammatory mechanisms is known to be associated with worse prognosis in advanced HF and after left ventricular assist device (LVAD) implantation, despite marked hemodynamic improvement. Aim of the study was to assess the relationship between INTERMACS classification and pro-inflammatory markers in ESHF patients supported by LVAD. Methods. Blood and urine samples of 24 ESHF patients [51 (47, 63) yrs] submitted to LVAD implantation were collected at pre-implant (4-24 hours before surgery) and at 1 post-LVAD (PL) week for assessment of pro-inflammatory markers [plasma interleukin (IL)-6, IL-8 levels and urine neopterin/creatinine ratio (Neo/Cr), a monocyte activation marker]. Results. At pre-implant, 11 pts had an INTERMACS profile 1 or 2 (group A), and 13 had a profile 3 or 4 (group B). Among the assessed inflammatory markers, only IL-6 levels were higher in A vs B groups, while IL-8 and Neo/Cr levels were comparable. After LVAD implantation the levels of pro-inflammatory markers increased in both groups, but at 1 PL week IL-8 levels were higher in A vs B groups. Conclusions. In patients undergoing LVAD implant, the more severe INTERMACS profiles are associated to higher IL-6 levels and to a more pronounced inflammatory response following device implantation. These data suggest that inflammation may contribute to inferior postoperative outcome despite similar hemodynamic improvement in patients with severe INTERMACS profiles.