Key result
Impaired peak left atrial longitudinal strain (OR 0.839) and elevated NT-proBNP >70 pg/ml (OR 22.377) were independent predictors of postoperative atrial fibrillation in patients undergoing CABG.
Why the study?
Do preoperative left-sided mechanical parameters measured by 2D speckle-tracking echocardiography predict postoperative atrial fibrillation in patients undergoing CABG?
Cohort (n=90)
No
Do preoperative left-sided mechanical parameters measured by 2D speckle-tracking echocardiography predict postoperative atrial fibrillation in patients undergoing CABG?
Odds Ratio: 0.839 (95% CI 0.73–0.963)
p-value: p=0.013
Preoperative assessment of left atrial and ventricular mechanics using 2D speckle-tracking echocardiography, combined with NT-proBNP and clinical factors, independently predicts postoperative atrial fibrillation in CABG patients.
May inform preoperative POAF risk stratification in CABG; hypothesis-generating and requires prospective validation.
OBJECTIVE: The aim of this study was to determine the role of left-sided mechanical parameters in postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG). METHODS: Ninety patients with coronary artery disease and normal left ventricular (LV) function in sinus rhythm were enrolled in the study. Preoperative LV and left atrial (LA) mechanics were evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE), including strain and rotation parameters, and volume indices. Patients were monitored in order to detect POAF during the postoperative period. RESULTS: Twenty-three of 90 patients (25.6%) developed POAF. Age (p<0.001) and preoperative beta blocker usage (p=0.001) were the clinical parameters associated with POAF. Left atrial maximum volume index (LAV[max]i) increased, and peak left atrial longitudinal strain (PALS) was impaired in POAF patients (p=0.001, p<0.001, respectively). Left ventricular twist (LVtw) and left ventricular peak untwisting velocity (UntwV) were augmented in POAF patients (p=0.013, p=0.009, respectively). Receiver operating characteristic analysis showed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels above 70 pg/ml and predicted POAF with a sensitivity of 74% and specificity of 78% (area under curve: 0.758, 95% confidence interval [CI] 0.631-0.894, p<0.001). Logistic regression analysis demonstrated that age (odds ratio [OR] 1.1, CI 1.01-1.20, p=0.034), preoperative beta blocker usage (OR 8.84, CI 1.36-57.28, p=0.022), NT-proBNP (values >70 pg/ml, OR 22.377, CI 3.286-152.381, p<0.001), PALS (OR 0.86, CI 0.75-0.98, p=0.023), and UntwV (OR 1.02, CI 1.00-1.04, p=0.029) were the independent predictors of POAF. CONCLUSION: The combination of 2D STE, clinical, and biochemical parameters may help predict POAF.
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Özcan Başaran (2015) conducted a cohort in Coronary artery disease (n=90). Peak left atrial longitudinal strain (PALS) vs. Normal PALS was evaluated on Postoperative atrial fibrillation (POAF) (OR 0.839, 95% CI 0.730-0.963, p=0.013). Impaired peak left atrial longitudinal strain (OR 0.839) and elevated NT-proBNP >70 pg/ml (OR 22.377) were independent predictors of postoperative atrial fibrillation in patients undergoing CABG.
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