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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Predictive role of left atrial and ventricular mechanical function in postoperative atrial fibrillation: a
Özcan Başaran1, Kürşat Tigen2, Gökhan Gözübüyük3
1Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey. basaran_ozcan@yahoo.com.
Insights
Left atrial strain and left ventricular untwisting are key mechanical predictors of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Combining these with clinical and biochemical markers improves POAF prediction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG).
- Identifying predictive factors for POAF is crucial for patient management and risk stratification.
- Left-sided cardiac mechanical parameters may play a significant role in POAF development.
Purpose of the Study:
- To investigate the association between preoperative left-sided mechanical parameters, assessed by 2D speckle-tracking echocardiography (STE), and the incidence of POAF in patients undergoing CABG.
- To identify independent predictors of POAF among echocardiographic, clinical, and biochemical markers.
Main Methods:
- Ninety patients with coronary artery disease undergoing CABG were prospectively studied.
- Preoperative left ventricular (LV) and left atrial (LA) mechanics were evaluated using 2D STE, including strain and rotation parameters.
- Patients were monitored for POAF, and logistic regression analysis identified independent predictors.
Main Results:
- POAF occurred in 25.6% of patients.
- Impaired peak left atrial longitudinal strain (PALS) and augmented left ventricular twist (LVtw) and untwisting velocity (UntwV) were associated with POAF.
- Age, beta-blocker use, elevated N-terminal pro-brain natriuretic peptide (NT-proBNP), PALS, and UntwV were independent predictors of POAF.
Conclusions:
- Preoperative left atrial and left ventricular mechanical dysfunction, assessed by 2D STE, are associated with POAF.
- A combination of 2D STE parameters, clinical factors (age, beta-blocker use), and NT-proBNP levels can aid in predicting POAF risk.
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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