Key result
High preoperative left atrial volume index (≥34 mL/m2) was associated with a significantly increased risk of postoperative atrial fibrillation compared to lower index values (8.1% vs 5.1%, adjusted OR 1.33) in patients undergoing non-cardiac surgery.
Why the study?
Postoperative atrial fibrillation is related to mortality after non-cardiac surgery, but the prognostic role of left atrial volume index had not been fully investigated in this setting.
Does a high preoperative left atrial volume index (LAVI) increase the risk of postoperative atrial fibrillation in patients undergoing non-cardiac surgery?
Cohort (n=83,097)
No
Does a high preoperative left atrial volume index (LAVI) increase the risk of postoperative atrial fibrillation in patients undergoing non-cardiac surgery?
Odds Ratio: 1.33 (95% CI 1.25–1.41)
Absolute Event Rate: 8.1% vs 5.1%
p-value: p=<0.001
Preoperative left atrial volume index ≥34 mL/m² is an independent predictor of postoperative atrial fibrillation in patients undergoing non-cardiac surgery.
Hypothesis-generating for POAF risk stratification in non-cardiac surgery; prospective validation required before clinical adoption.
Background Postoperative atrial fibrillation (POAF) is related to mortality after non-cardiac surgery. Left atrial volume index (LAVI) is known to be associated with prognosis and development of atrial fibrillation, but it has not been fully investigated in patients undergoing non-cardiac surgery. Materials and methods A total of 203,787 consecutive adult patients underwent non-cardiac surgery at our institution between January 2011 and June 2019. After identifying those with available LAVI estimated during preoperative echocardiography, we divided them into those with LAVI higher and lower than 34 mL/m 2 . The primary outcome was incidence of POAF. Results A total of 83,097 patients were enrolled in this study. The study patients were divided into the low (57,838 [69.6%]) and high (25,259 [30.4%]) LAVI groups. After an adjustment, higher LAVI was associated with increased incidence of POAF (5.1% vs. 8.1%; odds ratio [OR], 1.33; 95% confidence interval [CI], 1.25–1.41; p < 0.001). In 24,549 pairs of propensity-score-matched population, the result was similar (6.2% vs. 7.9%; OR, 1.30; 95% CI, 1.21–1.39; p < 0.001). The estimated threshold of LAVI associated with POAF was 36.4 mL/m 2 with an area under the curve of 0.571. Subgroup analysis in non-thoracic and thoracic surgery showed that the association between preoperative LAVI and POAF significantly interacted with diastolic dysfunction ( p for interaction < 0.001), and the observed association was valid in patients without diastolic dysfunction. Conclusion Preoperative LAVI was shown to be associated with POAF in non-cardiac surgery. Our result needs verification in further studies.
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Oh et al. (2022) conducted a cohort in Non-cardiac surgery (n=83,097). High preoperative left atrial volume index (≥34 mL/m2) vs. Low preoperative left atrial volume index (<34 mL/m2) was evaluated on Incidence of postoperative atrial fibrillation (POAF) (OR 1.33, 95% CI 1.25-1.41, p=<0.001). High preoperative left atrial volume index (≥34 mL/m2) was associated with a significantly increased risk of postoperative atrial fibrillation compared to lower index values (8.1% vs 5.1%, adjusted OR 1.33) in patients undergoing non-cardiac surgery.
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