TNF+250 polymorphism and hyperdynamic state in cardiac surgery with cardiopulmonary bypass

¹ Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain

^* To whom correspondence should be addressed. E-mail: joseluis.iribarren{at}gmail.com.

	Abstract

We have investigated genetic and clinical factors associated with hyperdynamic state (HS) after heart surgery with extracorporeal circulation (ECC). We performed a prospective cohort study of consecutive patients who underwent elective heart surgery with ECC. HS was defined as hyperthermia (>38 °C), cardiac index (CI) >3.5 l/min/m² and systemic vascular resistance index (SVRI) <1600 dynes·s/cm⁵·m². The study included demographic variables, gene polymorphisms (A/G) of tumor necrosis factor-beta (TNF+250), G/A-1082 of interleukin-10 (IL-10), polymorphism of interleukin-1 receptor antagonist (IL-1ra), comorbidity, type of surgery, serum levels of interleukin-6 (IL-6), and postoperative course. We used Pearson ² or Fischer exact test, and Student t-test for univariate analysis, with forward stepwise logistic regression for multivariate adjustment. Eighty patients were studied, of whom 22 (27.5%) developed HS. The presence of allele G of TNF+250 polymorphism was associated with an increased incidence of HS (68% vs 37%; P=0.011). In the multivariate analysis, a longer duration of ECC, and the presence of the G allele, were associated with the development of HS. The G allele of TNF+250 polymorphism, and prolonged extracorporeal circuit times, may favour the development of a hyperdynamic state after heart surgery with ECC. Keywords: Extracorporeal circulation; Cardiac surgery; Genetic polymorphism