Key result
Longer preoperative mitral deceleration time linked to ~35% lower odds of postoperative AF.
Why the study?
Diastolic dysfunction has been associated with AF in the community and postoperative setting, motivating this study to evaluate whether echocardiographic indices of abnormal left ventricular filling predict AF after cardiac surgery.
Does abnormal preoperative left ventricular filling (measured by deceleration time and E/e') predict postoperative atrial fibrillation and length of stay in patients undergoing cardiac surgery?
Cohort (n=233)
No
Does abnormal preoperative left ventricular filling (measured by deceleration time and E/e') predict postoperative atrial fibrillation and length of stay in patients undergoing cardiac surgery?
Answers are grounded in this paper and cite their sources.
Shorter early mitral inflow deceleration time on preoperative echocardiography independently predicts postoperative atrial fibrillation and longer hospital stay after cardiac surgery, aiding in preoperative risk stratification.
Objective: Diastolic dysfunction has been associated with the development of atrial fibrillation (AF) in the community and recently in the postoperative setting. We hypothesized that abnormal left ventricular filling predicts AF after cardiac surgery, a common marker of poor outcomes. Methods: Cohort study of 233 consecutive patients, who underwent coronary artery bypass grafting (CABG) and/or valve surgery. Early and late mitral inflow velocity (E, A) and deceleration time (DT) and early mitral annular velocity (e?) were obtained from echo within 6 months prior to cardiac surgery. Associations with postoperative AF were studied with multivariable logistic regression. Results: Postoperative AF occurred in 65 (28%) of patients, who were on average older, more likely to have had prior episodes of AF, had larger inferior vena cava diameter and shorter DT (189 ± 62ms vs. 214 ± 63ms, p=0.007). Multivariable adjusted analyses demonstrated only DT (odds ratio [OR] 0.65 (95% confidence interval [CI] 0.40-0.97), older age (OR 2.62 (95% CI 1.68 - 4.10) and prior episodes of atrial fibrillation (OR 7.20, CI 1.41-36.8) to be independent predictors of postoperative AF. Patients with a DT ≤ 200ms (n=117) had a significantly longer length of hospital stay compared with those who had DT > 200ms (n=116) (median 7 days (interquartile range [IQR] 5-10) vs. 6 days (IQR 5-7, p=0.0002). Conclusion: In patients who undergo cardiac surgery, a shorter DT of early mitral inflow identified greater risk for postoperative AF and a longer hospital stay. These results provide useful information for preoperative risk assessment and mechanistic understanding of postoperative AF.
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Rader et al. (2012) conducted a cohort in Cardiac surgery patients (coronary artery bypass grafting and/or valve surgery) (n=233). Early mitral inflow deceleration time (DT) and E/e' ratio on preoperative echocardiography vs. Normal / longer early mitral inflow deceleration time (e.g., DT > 200 ms, or 75th vs 25th percentile) was evaluated on Postoperative atrial fibrillation requiring treatment with rate-controlling or anti-arrhythmic medications or electrical cardioversion before hospital discharge (OR 0.65, 95% CI 0.40-0.97). Shorter preoperative early mitral inflow deceleration time independently predicted postoperative atrial fibrillation after cardiac surgery (adjusted OR 0.65, 95% CI 0.40-0.97).
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