Interleukin-6 is independently associated with right ventricular function in pulmonary arterial hypertension

BACKGROUND: An elevated serum level of interleukin-6 (IL-6) in pulmonary arterial hypertension (PAH) patients results in a greater symptom burden and increased mortality; however, the mechanisms underlying these observations remain unclear. Because both pre-clinical and clinical data associate elevated IL-6 levels with impaired cardiac function, we hypothesized that the adverse effects of IL-6 in PAH result, in part, from right ventricular (RV) dysfunction. METHODS: We analyzed the relationship between IL-6 and RV function in 40 patients with PAH identified in our institutional PAH registry. Serum IL-6 levels was quantified by enzyme-linked immunoassay. RESULTS: PAH patients had higher IL-6 levels than age- and gender-matched controls. Circulating IL-6 levels correlated inversely with echocardiography-based measures of RV function and RV pulmonary artery (RV-PA) coupling. When dividing PAH patients by median IL-6 level, patients with higher IL-6 had significantly worse RV function (fractional area change [FAC] 23 +/- 12% vs 38 +/- 11%, tricuspid annular plane systolic excursion [TAPSE] 1.3 +/- 0.3 cm vs 2.1 +/- 0.5 cm), impaired RV-PA coupling (0.6 +/- 0.5%/mm Hg vs 0.9 0.5%/mm Hg), higher right atrial pressure (13 +/- 7 mm Hg vs 9 +/- 5 mm Hg), reduced cardiac index (2.0 +/- 0.5 liters/min/m(2) vs 2.8 +/- 1.0 liters/min/m(2)) and lower stroke volume (48 +/- 20 ml vs 70 +/- 28 ml). In contrast, the relationships between IL-6 and mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and pulmonary arterial compliance (PAC) were not significant. Finally, IL-6 was independently associated with RV function and RV-PA coupling after adjusting for static (PVR) and pulsatile (PAC) after-load on the RV. CONCLUSIONS: Serum IL-6 levels are independently associated with RV function and RV-PA coupling in PAH. Patients with higher IL-6 levels have more severe RV dysfunction and diminished RV-PA coupling despite a comparable severity of pulmonary vascular disease. (C) 2018 International Society for Heart and Lung Transplantation. All rights reserved.