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 intervals following 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 preceding surgery. Three (15%) patients developed PPS. Their sera were negative for AHA on the day they were diagnosed as suffering from 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 90 days 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 in the pathogenesis of PPS, but may rather be an epiphenomenon, reflecting an immune response to pericardial and/or myocardial injury.