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Left Atrial Diameter Index Predicts Cerebrovascular Events After POAF Following CABG
Arda Can Doğan1, Ali Rıza Demir2, Alkım Ateşli Yazıcı3
1TC Sağlık Bakanlığı İskenderun Devlet Hastanesi, Hatay, Turkey.
Insights
The left atrial diameter index (LADI) can predict cerebrovascular events (CVE) in patients who develop postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). High LADI indicates a significantly increased risk of CVE post-surgery.
Area of Science:
- Cardiology
- Neurology
- Medical Diagnostics
Background:
- Postoperative atrial fibrillation (POAF) is a common complication following coronary artery bypass grafting (CABG).
- POAF is associated with an elevated risk of cerebrovascular events (CVE), both short-term and long-term.
- Predictive markers for CVE in this patient population are crucial for risk stratification.
Purpose of the Study:
- To evaluate the prognostic capability of the left atrial diameter index (LADI) in predicting CVE.
- To assess LADI's value in patients who experienced POAF after isolated CABG but were discharged in sinus rhythm.
- To determine if LADI can aid in identifying patients at higher risk for CVE post-CABG.
Main Methods:
- A cohort of 392 patients who developed POAF after isolated CABG and were discharged in sinus rhythm was analyzed.
- Preoperative LADI was measured, and an optimal cutoff of 21.2 mm/m² was established.
- Patients were categorized into low (≤21.2 mm/m²) and high (>21.2 mm/m²) LADI groups.
- Cox proportional hazards modeling and Kaplan-Meier analysis were used to assess the association between LADI and CVE over a mean follow-up of 42.4 months.
Main Results:
- The overall incidence of CVE was 7.7%, with 2.0% occurring in-hospital.
- Patients with high LADI exhibited a significantly higher CVE incidence (19.8%) compared to those with low LADI (2.8%).
- Multivariable analysis identified high LADI, older age, hypertension, and congestive heart failure as independent predictors of CVE.
Conclusions:
- The left atrial diameter index (LADI) is a valuable and easily measured preoperative parameter.
- LADI independently predicts long-term cerebrovascular event risk in patients with POAF after CABG.
- LADI can enhance postoperative risk stratification for CVE in this specific patient group.
Objective:
Postoperative atrial fibrillation (POAF) is a frequent complication after coronary artery bypass grafting (CABG) and is linked to increased short- and long-term stroke risk. This study evaluated the prognostic value of the left atrial diameter index (LADI) for predicting cerebrovascular events (CVE) in patients undergoing isolated CABG who developed POAF, had no prior atrial fibrillation (AF), and were discharged in sinus rhythm.
Materials And Methods:
Among 2094 patients undergoing isolated CABG between June 2015 and June 2022, 392 consecutive patients with POAF and discharge in sinus rhythm met inclusion criteria. LADI was calculated preoperatively, and an optimal cutoff (21.2 mm/m²) was determined via receiver operating characteristic (ROC) curve and Youden index. Patients were classified as low (≤21.2 mm/m²) or high (>21.2 mm/m²) LADI. The association between LADI and CVE was assessed over a mean follow-up of 42.4±20.0 months using Cox proportional hazards modeling.
Results:
Thirty patients (7.7%) experienced a CVE, including 8 in-hospital cases (2.0%). CVE incidence was higher in the high LADI group compared to the low LADI group (19.8% vs. 2.8%). Multivariable analysis identified older age, hypertension, congestive heart failure, and high LADI as independent CVE predictors. Kaplan-Meier analysis confirmed significantly higher CVE rates in the high LADI group (log-rank p<0.001).
Conclusion:
In patients developing POAF after isolated CABG, LADI is a simple, easily obtainable parameter that independently predicts long-term CVE risk and may aid in postoperative risk stratification.
