Key result
Elevated preoperative plasma big endothelin-1 (>0.235 pmol/l) independently predicted postoperative atrial fibrillation (OR 100.7) in patients with hypertrophic cardiomyopathy undergoing surgical septal myectomy.
Why the study?
Postoperative atrial fibrillation is a common complication associated with poor outcomes after surgical myectomy in HOCM, but the predictive role of plasma big endothelin-1 has not been well studied.
Does elevated preoperative plasma big endothelin-1 predict new-onset postoperative atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy undergoing surgical septal myectomy?
Cohort (n=118)
No
Does elevated preoperative plasma big endothelin-1 predict new-onset postoperative atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy undergoing surgical septal myectomy?
Effect estimate: OR 100.7 (95% CI 5.0-2020.0)
Absolute Event Rate: 32.4% vs 6.6%
p-value: p=0.003
Elevated preoperative plasma big endothelin-1 is an independent predictor of new-onset postoperative atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy undergoing surgical septal myectomy.
May aid POAF risk stratification before myectomy in obstructive HCM; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complication in patients with obstructive hypertrophic cardiomyopathy (HOCM) who undergo surgical myectomy. POAF is associated with poor outcome. The role of plasma big endothelin-1 level in predicting atrial fibrillation after surgical septal myectomy in HOCM patients has not well been studied. METHODS: A total of 118 patients with HOCM who underwent surgical septal myectomy were recruited in this study. Plasma big endothelin-1 level was measured. The heart rhythm was continuously monitored during hospital stay. Preoperative, intraoperative, and postoperative variables were collected. RESULTS: POAF developed among 26 of the 118 patients (22%) in this study. Compared with those without POAF, patients with POAF were significantly older (53.5 ± 10.6 vs. 47.3 ± 13.6 years, P = 0.033), more likely to undergo mitral valve surgery (38.5% vs. 18.5%, P = 0.032), and had higher plasma big endothelin-1 levels (0.41 ± 0.19 vs. 0.27 ± 0.14 pmol/l, P = 0.001), longer hospital stay (9.1 ± 3.7 vs. 7.5 ± 2.8 days, P = 0.022), larger preoperative left atria (48.0 ± 5.2 vs. 44.1 ± 5.9 mm; P = 0.003). In the receiver operating characteristic curve analysis, the area under the curve for big endothelin-1 was 0.734 (95% CI, 0.634 to 0.834, P<0.001). In multivariate logistic regression analysis, preoperative big endothelin-1 level (OR 100.7, 95%CI: 5.0-2020.0, P = 0.003) and left atrial diameter (OR 1.106, 95%CI: 1.015-1.205, P = 0.022) were independent predictors of POAF. CONCLUSION: Elevated preoperative plasma big endothelin-1 level is an independent predictor of POAF in HOCM patients undergoing surgical septal myectomy.
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Song et al. (2019) conducted a cohort in Obstructive hypertrophic cardiomyopathy (n=118). High preoperative plasma big endothelin-1 (>0.235 pmol/l) vs. Low preoperative plasma big endothelin-1 (≤0.235 pmol/l) was evaluated on Postoperative atrial fibrillation (POAF) (OR 100.7, 95% CI 5.0-2020.0, p=0.003). Elevated preoperative plasma big endothelin-1 (>0.235 pmol/l) independently predicted postoperative atrial fibrillation (OR 100.7) in patients with hypertrophic cardiomyopathy undergoing surgical septal myectomy.
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