Role of plasminogen activator inhibitor-1 polymorphism on the development of vasoplegic syndrome associated with cardiopulmonary bypass
KeywordsCardiopulmonary Bypass Cardiac Index Binary Logistic Regression Resistance Index Systemic Vascular Resistance
Vasoplegic syndrome (VS) after cardiac surgery with cardiopulmonary bypass (CPB) can vary from mild to severe complication and it appears with an incidence ranging between 5% and 15%. The etiology is not completely elucidated but risk factors such as temperature and duration of cardiopulmonary bypass and preoperative treatment with angiotensin-converting enzyme (ACE) inhibitors have been associated . We wanted to investigate the possible role of several genetic polymorphisms in patients with VS after elective CPB.
We performed a nested case–control study of 50 patients undergoing CPB, 27 (54%) men and 23 (46) women, mean age 66.5 (SD 9.6) years. VS was defined as systemic vascular resistance index lower than 1,600 dyn∙seg/cm5/m2 and a cardiac index greater than 2.5 l/min/m2 within the first 4 hours after surgery. We recorded data related to hemodynamic parameters at different postoperative time points, at ICU admission (0 hours), 4 and 24 hours after surgery, and the polymorphism of the following genes: plasminogen activator inhibitor-1 (PAI-1) and β-TNF + 250. In addition, 23 neutral markers were genotyped to follow genomic control strategies that would detect spurious associations due to population substructure. We used the Pearson chi-squared test and binary logistic regression. SPSS version 12.1 was used.
The PAI-1 polymorphism (homozygous 5G/G) was independently associated with the onset of VS.