The Journal of Thoracic and Cardiovascular Surgery
Adult: CoronaryPreoperative left atrial strain abnormalities are associated with the development of postoperative atrial fibrillation following isolated coronary artery bypass surgery
Graphical abstract
A total of 211 patients undergoing isolated coronary artery bypass grafting (CABG) who had a retrospective analysis of their preoperative standard echo parameters and strain analysis of their LA, left ventricle, and right ventricle using 2-dimensional (2D) speckle-tracking echocardiogram analysis. The patients were divided into 2 groups for comparison based on whether or not they developed postoperative atrial fibrillation (POAF). The 50 patients who had abnormal preoperative LA strain measurements developed POAF. The 161 patients who had normal preoperative LA strain measurements did not develop POAF.
Section snippets
Patient Cohort
Between January 1, 2016, and December 31, 2018, 211 consecutive patients with a preoperative left ventricular (LV) ejection fraction of ≥50%, no history of AF or previous episodes of AF, recent acute coronary syndrome (<30 days), active inflammatory or infectious diseases, chronic kidney disease (creatinine >1.5 mg/dL), neoplasms, no previous interventional treatment of AF, and no history of valve surgery, or moderate-or-greater valve regurgitation, underwent elective isolated CABG at
Results
POAF occurred in 23.7% (n = 50) of the 211 patients (mean age: 64.6 ± 9.6 years; 18% female). The only preoperative demographic that was significantly different between the POAF and no-POAF groups was age, with patients who developed POAF being an average of 4 years older (Table 1). Preoperatively, 49% of the patients without POAF and 58% of the patients with POAF were on aspirin (P = .40). In addition, 2% of the patients without POAF and 4% of the patients with POAF were on preoperative
Discussion
POAF occurs in 15% to 40% of patients following CABG surgery and has been shown to prolong postoperative inpatient stays, increase hospitalization costs, and increase morbidity and mortality rates.2,20,21 Since there is currently no definitive way to identify preoperatively which patients will develop POAF, prophylactic measures against the development of POAF must be applied in all patients undergoing CABG in hopes of benefitting the ones who develop POAF (23.7% in our study). We sought to
Conclusions
None of the standard preoperative conventional echocardiographic parameters of the LA, LV, or RV were associated with POAF in our patients undergoing isolated CABG. However, speckle-tracking analysis of strain measurements in the left atrium were clearly associated with the risk of developing POAF following CABG (Video 1). This is the first study to document the association between preoperative LA strain parameters and the development of POAF following CABG.
If confirmed prospectively in a
References (27)
- et al.
Postoperative atrial fibrillation and mortality: do the risks merit changes in clinical practice?
J Am Coll Cardiol
(2004) - et al.
Postoperative atrial fibrillation and mortality after coronary artery bypass surgery
J Am Coll Cardiol
(2004) - et al.
Postoperative atrial fibrillation: sex-specific characteristics and impact on survival
J Thorac Cardiovasc Surg
(2020) - et al.
The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades
J Thorac Cardiovasc Surg
(2011) - et al.
ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography)
J Am Soc Echocardiogr
(2003) - et al.
A test in context: myocardial strain measured by speckle-tracking echocardiography
J Am Coll Cardiol
(2017) - et al.
Normal ranges of left ventricular strain: a meta-analysis
J Am Soc Echocardiogr
(2013) - et al.
Postoperative atrial fibrillation is associated with higher scores on predictive indices
J Thorac Cardiovasc Surg
(2019) - et al.
Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?
J Am Coll Cardiol
(2006) - et al.
Usefulness of left ventricular diastolic dysfunction assessed by pulsed tissue Doppler imaging as a predictor of atrial fibrillation recurrence after successful electrical cardioversion
Am J Cardiol
(2011)
Postoperative atrial fibrillation after coronary artery bypass grafting surgery: a two-dimensional speckle tracking echocardiography study
Heart Lung Circ
Usefulness of postoperative atrial fibrillation as an independent predictor for worse early and late outcomes after isolated coronary artery bypass grafting (multicenter Australian study of 19,497 patients)
Am J Cardiol
Pre-operative left atrial mechanical function predicts risk of atrial fibrillation following cardiac surgery
JACC Cardiovasc Imaging
Cited by (11)
Atrial Speckle Tracking Echocardiography for Detecting Atrial Fibrillation in Cryptogenic Stroke: A Meta-Analysis
2023, Current Problems in CardiologyCommentary: Atrial fibrillation after cardiac surgery: Getting under the hood
2022, Journal of Thoracic and Cardiovascular SurgeryCommentary: POAF goes POOF!
2022, Journal of Thoracic and Cardiovascular Surgery