Key result
An increased preoperative tricuspid Et/E't ratio independently predicts the onset of postoperative atrial fibrillation (OR 1.20) in patients with moderate-to-severe left ventricular systolic dysfunction undergoing CABG.
Why the study?
Patients with moderate-severe left ventricular systolic dysfunction undergoing CABG have high mortality and morbidity, but the impact of right ventricular diastolic function on postoperative outcomes is unclear.
Does preoperative right ventricular diastolic function predict postoperative atrial fibrillation in patients with moderate-severe LV systolic dysfunction undergoing CABG?
Cohort (n=67)
No
Does preoperative right ventricular diastolic function predict postoperative atrial fibrillation in patients with moderate-severe LV systolic dysfunction undergoing CABG?
Odds Ratio: 1.2 (95% CI 1.01–1.43)
p-value: p=0.043
Preoperative assessment of right ventricular diastolic function, specifically the tricuspid Et/E't ratio, independently predicts postoperative atrial fibrillation in patients with moderate-severe left ventricular systolic dysfunction undergoing CABG.
RV diastolic assessment may stratify post-CABG AF risk in low-EF patients; leaves open whether intervention alters outcomes.
Background: Patients with moderate-severe left ventricular systolic dysfunction undergoing coronary artery bypass graft (CABG) surgery are at high risk of mortality and morbidity. Our aim is to evaluate the right ventricular (RV) diastolic function in these patients, and monitor its effects on postoperation outcomes. Materials and Methods: In a cohort study, patients with moderate-severe left ventricular systolic dysfunction (ejection fraction ≤35%) who were candidate for CABG were included. Baseline transthoracic echocardiography (TTE) was performed, and RV diastolic function measures were obtained. After CABG, the length of intubation, inotrope dependency, hospital stay in intensive care unit and ward, in-hospital and after discharge mortality, postoperative atrial fibrillation (POAF) were evaluated in all patients. Results: Sixty-seven patients were prospectively included in the study. The mean ± standard deviation age of our patients was 61.4 ± 9.3. There was no difference between grades of RV diastolic function and postoperative outcomes. However, we found significant difference between grades of RV diastolic function and onset of in hospital, and total POAF ( P -value = 0.017). Multivariate analysis demonstrated that preoperative tricuspidE t /E’ t (ratio of peak early-diastolic flow rate across the tricuspid valve orifice to peak early-diastolic velocity at the lateral tricuspid annulus), left atrial volume and “high risk” Euroscore II were independent predictors for POAF during hospitalization and total POAF in patients with moderate to severely impaired left ventricular systolic function ( P -values were 0.04, 0.003 and 0.001, respectively). Conclusion: We believe that patients with increased tricuspid E t /E’ t are high risk for POAF; therefore, any risk score for POAF should include a comprehensive TTE including evaluation of RV diastolic function before surgery.
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Sattarzadeh et al. (2022) conducted a cohort in Moderate-severe left ventricular systolic dysfunction undergoing CABG (n=67). Preoperative tricuspid Et/E't ratio vs. Lower tricuspid Et/E't ratio was evaluated on Total postoperative atrial fibrillation (POAF) (OR 1.20, 95% CI 1.01-1.43, p=0.043). An increased preoperative tricuspid Et/E't ratio independently predicts the onset of postoperative atrial fibrillation (OR 1.20) in patients with moderate-to-severe left ventricular systolic dysfunction undergoing CABG.
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