Key result
Worse RV free-wall longitudinal strain is linked to ~44% higher post-OPCAB AF odds.
Why the study?
The prognostic value of preoperative 2-dimensional strain of the left ventricle, right ventricle, and left atrium for predicting new-onset postoperative atrial fibrillation and adverse outcomes after off-pump coronary artery bypass grafting was unclear.
Does preoperative speckle-tracking strain of the left ventricle, right ventricle, and left atrium predict new-onset postoperative atrial fibrillation in adults undergoing elective isolated off-pump coronary artery bypass grafting?
Cohort (n=150)
No
Does preoperative speckle-tracking strain of the left ventricle, right ventricle, and left atrium predict new-onset postoperative atrial fibrillation in adults undergoing elective isolated off-pump coronary artery bypass grafting?
Preoperative right ventricular and left atrial strain provide independent prognostic value for predicting postoperative atrial fibrillation after off-pump CABG, potentially guiding intensified rhythm monitoring and prophylaxis.
Answers are grounded in this paper and cite their sources.
RVFWLS and left atrial reservoir strain independently predicted POAF after OPCAB; leaves open whether preoperative strain refines risk stratification.
OBJECTIVES To determine whether preoperative speckle-tracking strain of the left ventricle, right ventricle, and left atrium predicts new-onset postoperative atrial fibrillation (POAF) and other adverse outcomes after off-pump coronary artery bypass grafting (OPCAB). DESIGN Prospective, single-center, observational, prognostic cohort study. SETTING Tertiary-care university cardiac surgical center in western India. PARTICIPANTS One hundred fifty consecutive adults undergoing elective isolated OPCAB (January 2024-March 2025). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Transthoracic echocardiography with offline speckle tracking was performed within 24 hours before surgery; left ventricular (LV) global longitudinal strain (GLS), right ventricular free-wall longitudinal strain (RVFWLS) and left atrial (LA) reservoir strain (peak atrial longitudinal strain [PALS]) were measured. POAF occurred in 62 of 150 patients (41.3%). Patients with POAF had less negative LV GLS (-16.07% v -17.85%), less negative RVFWLS (-21.85% v -24.47%), lower PALS (32.45% v 38.31%), and larger LA volume index (LAVI) (43.71 mL/m² v 33.01 mL/m²) (all p < 0.001). LAVI showed the highest discrimination (area under the curve [AUC], 0.867), followed by RVFWLS (AUC, 0.771), LV GLS (AUC, 0.766), and PALS (AUC, 0.765); LV ejection fraction did not discriminate (AUC, 0.541). After adjustment for age, European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, and LAVI, RVFWLS (adjusted odds ratio, 1.436; p = 0.008) and PALS (1.118 per 1% decrement, p = 0.039) were the only strain parameters that remained independent predictors, together with LAVI and age. RVFWLS was also independently associated with prolonged inotropic support beyond 48 hours. CONCLUSIONS Preoperative strain of the left ventricle, right ventricle, and left atrium carries prognostic information for POAF after OPCAB, but only RVFWLS and LA reservoir strain were independent strain predictors after adjustment; these parameters may identify a high-risk subgroup warranting intensified rhythm monitoring and prophylaxis. These associations do not establish causation.
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Madanaik et al. (2026) conducted a cohort in Elective isolated off-pump coronary artery bypass grafting (OPCAB) (n=150). Preoperative speckle-tracking strain (LV, RV, and LA) was evaluated on New-onset postoperative atrial fibrillation (POAF) (adjusted OR 1.436, p=0.008). Preoperative right ventricular free-wall longitudinal strain (adjusted OR 1.436, p=0.008) and left atrial reservoir strain independently predicted postoperative atrial fibrillation after OPCAB.
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