Key result
Combined preoperative AEMI and LVEF predicts post-CABG atrial fibrillation with ~98% sensitivity.
Why the study?
AF is the most common arrhythmia after CABG, occurring in 17-33% of patients. This study evaluated various preoperative echocardiographic parameters as predictors of post-CABG AF.
Do preoperative echocardiographic parameters such as atrial electromechanical interval (AEMI) and left ventricular ejection fraction predict postoperative atrial fibrillation in patients undergoing CABG?
Cohort (n=200)
Do preoperative echocardiographic parameters such as atrial electromechanical interval (AEMI) and left ventricular ejection fraction predict postoperative atrial fibrillation in patients undergoing CABG?
Preoperative measurement of atrial electromechanical interval (AEMI) combined with left ventricular ejection fraction strongly predicts the development of postoperative atrial fibrillation after CABG with high sensitivity and specificity.
Answers are grounded in this paper and cite their sources.
May inform preoperative AF risk assessment in CABG; leaves open prospective validation before clinical adoption.
Background: Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass grafting (CABG), with a rate of occurrence of 17-33% in different studies.This study is aimed at evaluating various preoperative echo parameters like left artery (LA) diameter, LA volume index, left ventricular ejection fraction (LVEF), A wave velocity, tissue Doppler imaging (TDI) A wave velocity and atrial electromechanical interval (AEMI), which can be used as predictors of post CABG AF.Methods: A total of 200 patients who underwent CABG were included.Demographic variables, clinical parameters and routine investigations were done.Pre op ECG and various 2D echo parameters were taken as per standard protocol suggested by American Society of Echocardiography.Results: Mean age was 58.8 ± 9.1 years (range 38-88 years).Forty-three patients (21.5%) had developed POAF (Post Operative AF).The incidence was higher in older age (64.3 ± 7.4 vs 57.2 ± 8.9 respectively, p = 0.0001) and with longer P wave duration (90.23 ± 19.7 and 74.3 ± 21.7 respectively, p = 0.0001).For echocardiographic parameters in univariate analysis, difference in AEMI (138 ± 11.7 and 92 ± 9.9 respectively, p = 0.0001), LA volume index (37.6 ± 5.8 and 28.5 ± 4.6 respectively, p = 0.0001), LA diameter (3.8 ± 0.29 and 3.6 ± 0.25 respectively, p = 0.0001) and ejection fraction (48.3 ± 4.8 and 53.9 ± 5.2 respectively, p = 0.0001) were statistically highly significant.Multiple logistic regression analysis revealed R 2 value equal to 0.98.In multivariate analysis, AEMI was found to be the best predictor (p = 0.48).A cutoff point of 117 ms yielded 95.3% sensitivity and 94.0% specificity.Combination of AEMI and ejection fraction (EF) was found to predict the occurrence of POAF with 97.7% sensitivity and 99.4% specificity and was statistically significant (AEMI, p = 0.005 and EF, p = 0.05).Conclusion: Older age and longer P wave duration were found to be significantly associated with occurrence of POAF.Among the echo parameters in univariate analysis, mean AEMI, LA volume index and LA diameter were significantly higher in AF group.In multivariate analysis, AEMI was found to be the best predictor with a cutoff point of 117 ms.Combining AEMI and EF can strongly predict the occurrence of POAF.
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Kataria et al. (2017) conducted a cohort in Patients undergoing coronary artery bypass grafting (CABG) (n=200). Preoperative echocardiographic parameters (LA diameter, LA volume index, LVEF, A wave velocity, TDI A wave velocity, and atrial electromechanical interval [AEMI]) was evaluated on Postoperative atrial fibrillation (POAF) (p=0.0001). Combining preoperative atrial electromechanical interval (AEMI) and ejection fraction predicted post-CABG AF with 97.7% sensitivity and 99.4% specificity (AEMI p=0.005; EF p=0.05).
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