Adult: Coronary
Preoperative left atrial strain abnormalities are associated with the development of postoperative atrial fibrillation following isolated coronary artery bypass surgery

https://doi.org/10.1016/j.jtcvs.2020.09.130Get rights and content

Abstract

Objective

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG). Currently, there is no reliable way to determine preoperatively which patients will develop POAF following CABG. The aim of this study was to determine whether preoperative left atrial (LA) strain analysis might identify patients destined to develop POAF following CABG.

Methods

From 2016 to 2018, 211 patients who had a preoperative left ventricular ejection fraction >50% and adequate preoperative, predischarge, and follow-up echo images for interpretation underwent isolated CABG surgery. Postoperatively, patients had continuous rhythm monitoring until hospital discharge. Retrospective speckle-tracking analysis of preoperative echocardiograms was performed to calculate preoperative left ventricular global longitudinal strain and LA compliance and contraction strains in 92 matched patients. Multivariate logistic regression and Cox proportional hazards models were used to determine the predictors of POAF after CABG.

Results

POAF occurred in 50 patients (24%). They were older, had longer intensive care unit and hospital stays, and a slightly greater 30-day mortality (P = .07). Preoperative LA volume index was larger in the patients with POAF but still “normal” as defined by current guidelines. However, preoperative LA compliance and contraction strains were significantly lower in patients who developed POAF after CABG.

Conclusions

Decreased preoperative LA strain measurements, especially LA-fractional area change, LA-emptying fraction, and LA-reservoir strain, taken jointly, are more specific and sensitive than other preoperative parameters in identifying patients who will develop POAF following CABG. The ability to identify patients preoperatively who are destined to develop POAF following CABG provides a basis for limiting POAF prophylactic therapy to only those patients undergoing CABG who are most likely to benefit from it rather than to all patients undergoing CABG.

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.

  1. Download : Download high-res image (177KB)
  2. Download : Download full-size image

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)

Cited by (11)

View all citing articles on Scopus
View full text