医学
心房颤动
心脏病学
内科学
危险系数
动脉
斑点追踪超声心动图
心脏外科
接收机工作特性
冠状动脉搭桥手术
入射(几何)
置信区间
心力衰竭
射血分数
物理
光学
作者
María Pastore,Anna Degiovanni,Leonardo Grisafi,Giulia Renda,Martina Sozzani,Andrea Giordano,Cosimo Salvatici,Veronica Lorenz,Francesca Pierfelice,Carla Cappelli,Filomena De Donno,Marta Focardi,Fabrizio Ricci,Umberto Benedetto,Sabina Gallina,Matteo Cameli,Giuseppe Patti
出处
期刊:Circulation-cardiovascular Imaging
[Ovid Technologies (Wolters Kluwer)]
日期:2024-01-01
卷期号:17 (1)
被引量:1
标识
DOI:10.1161/circimaging.123.015969
摘要
BACKGROUND: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery being associated with poorer outcomes. Revealing before the operation of left atrial subtle structural/functional abnormalities may help to identify patients at increased risk of POAF. We investigated the role of left atrial strain parameters by preoperative speckle tracking echocardiography as independent predictors of POAF in patients undergoing coronary artery bypass graft. METHODS: Consecutive patients undergoing isolated coronary artery bypass graft were prospectively enrolled at three Italian centers. All patients underwent transthoracic echocardiography before the operation. The occurrence of POAF up to discharge was monitored. RESULTS: Overall, a total of 310 patients were included. POAF was demonstrated in 103 patients (33%). At receiver operating characteristic curve analysis, lower global peak atrial longitudinal strain (PALS) values significantly predicted the risk of POAF (area under the curve, 0.74; P <0.001). The optimal cutoff value for the arrhythmia prediction was a global PALS value <28%, with a specificity of 86% and a sensitivity of 36%. The incidence of POAF was 51% in patients with global PALS <28% versus 14% in those with PALS ≥28% ( P <0.001), with a POAF-free survival at Kaplan-Meier analysis of 45.4% and 85.7%, respectively ( P <0.001). At multivariate analysis, a global PALS <28% carried a 3.6-fold higher risk of POAF (hazard ratio, 3.6 [95% CI, 2.2–5.9]; P <0.001). The risk increase was even higher when PALS <28% was associated with age ≥70 years (adjusted hazard ratio, 11.2 [4.7–26.6], P <0.001). CONCLUSIONS: A presurgery global PALS <28% is a specific parameter to stratify patients at increased risk of POAF after coronary artery bypass graft. This assessment can be useful to identify patients at higher arrhythmic risk in whom perioperative preventive strategies and stricter monitoring aimed at early diagnosing and treating POAF may be applied.
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