Key result
Postoperative left ventricular diastolic dysfunction grade 3 (OR 8.3; 95% CI 4.11-25.37) and increased long-axis left atrial dimension independently predicted postoperative atrial fibrillation.
Why the study?
Do early postoperative transthoracic echocardiography findings predict postoperative atrial fibrillation in patients undergoing cardiac surgery?
Cohort (n=147)
Do early postoperative transthoracic echocardiography findings predict postoperative atrial fibrillation in patients undergoing cardiac surgery?
Odds Ratio: 8.3 (95% CI 4.11–25.37)
p-value: p=<0.001
Early postoperative TTE findings, specifically long-axis left atrial dimension and diastolic dysfunction grade, are powerful independent predictors of postoperative atrial fibrillation after cardiac surgery.
Long-axis LA dimension and diastolic grades on early postop TTE were associated with POAF; hypothesis-generating for risk models pending validation.
PURPOSE: Postoperative atrial fibrillation (POAF) is frequent after cardiac surgery. We aimed to establish a predictive model of POAF based on postoperative transthoracic echocardiography (TTE) findings. METHODS: This study included 147 patients (aged 67 ± 11 years; 109 men) undergoing coronary artery bypass grafting and/or aortic valve replacement. TTE and Doppler tissue imaging were performed on intensive care unit arrival after surgery. All patients were continuously monitored during hospitalization. The end point was the appearance of POAF. RESULTS: POAF appeared in 37 patients (25.2%). These patients were older (69 ± 16 vs. 65 ± 12 years; P < 0.001) and had increased long axis of the left atrium (LA) dimension (5.4 ± 1 vs. 4.8 ± 0.9 cm, P = 0.02), lower early diastolic velocity of the mitral annulus (e') (6.9 ± 2.1 vs. 8 ± 1.8 cm/sec; P < 0.01), and higher early diastolic pulsed Doppler mitral ratio (E)/e' (E/e') (17.4 ± 6.8 vs. 13.8 ± 6; P = 0.01). Left ventricle diastolic dysfunction grade (DFG) of 2 or 3 relative to grade 0 was significant: odds ratio (OR) 22.5, 95% confidence interval (CI) 4.52-57.2; P < 0.001, and OR: 23.6, 95% CI: 3.57-60.1; P = 0.001), respectively. On multivariate analysis, the independent predictors of POAF were age (OR: 1.10, 95% CI: 1.01-1.18; P < 0.05), long-axis LA dimension (OR: 6.24, 95% CI: 1.97-8.23; P = 0.0017), DFG-2 (OR: 4.1, 95% CI: 1.57-15.81; P < 0.001), and DFG-3 (OR: 8.3, 95% CI: 4.11-25.37; P < 0.001). CONCLUSIONS: Apart from age, the simple determination by postoperative TTE of long-axis LA dimension and DFG after cardiac surgery proved to be powerful independent predictors of POAF and may be useful for risk stratification of these patients.
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Lacalzada‐Almeida et al. (2016) conducted a cohort in Postoperative atrial fibrillation (n=147). Postoperative transthoracic echocardiography findings (diastolic dysfunction and LA dimension) vs. Normal findings or lower grades was evaluated on Appearance of postoperative atrial fibrillation (POAF) (OR 8.3, 95% CI 4.11-25.37, p=<0.001). Postoperative left ventricular diastolic dysfunction grade 3 (OR 8.3; 95% CI 4.11-25.37) and increased long-axis left atrial dimension independently predicted postoperative atrial fibrillation.
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