Preoperative Left Atrial Strain Reservoir and the Risk of Postoperative Atrial Fibrillation After Major Lung...

Postoperative atrial fibrillation (POAF) is the most frequent arrhythmia and cardiovascular complication following major lung resection. Left atrial reservoir strain (LASr) has been associated with new-onset atrial fibrillation in various cardiovascular settings. This study aimed to evaluate the association between preoperative LASr and the occurrence of POAF after major lung resection.

Ancillary analysis of a prospective, single-center echocardiographic cohort study.

Tertiary university hospital in France.

Adult patients scheduled for major lung resection between September 2021 and September 2023.

All participants underwent preoperative transthoracic echocardiography within 24 hours of surgery. LASr was quantified using automated speckle-tracking analysis with dedicated left atrial strain software.

A total of 156 patients were included (lobectomy in 110 [71%], pneumonectomy in 7 [5%], and segmentectomy in 39 [25%]). POAF occurred in 19 patients (12%). LASr was significantly lower in patients in whom POAF developed than in those without POAF (28% [interquartile range, 21%-36%] v 42% [interquartile range, 35%-50%], p < 0.001). An LASr threshold < 33% identified patients at higher risk of POAF, with an area under the curve of 0.80 (95% confidence interval [CI], 0.68-0.93). In multivariable Cox regression analysis, LASr < 33% was independently associated with POAF (hazard ratio, 9.28; 95% CI, 3.28-26.24; p < 0.001). The negative predictive value of LASr ≥ 33% for POAF was 95%. The cumulative 15-day incidence of POAF was 28% (95% CI, 15%-42%) in patients with LASr < 33% versus 3.5% (95% CI, 1%-8%) in those with LASr ≥ 33% (p < 0.0001).

In patients undergoing major lung resection, preoperative LASr assessment may help identify those at low risk of POAF. LASr ≥ 33% was associated with a very low likelihood of POAF, and use of this threshold may support perioperative risk stratification strategies.