Left Atrial Myopathy As Assessed On Echocardiography Is Predictive Of Atrial Fibrillation Recurrence After Coronary Artery Bypass Surgery,Journal of cardiac failure

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Left Atrial Myopathy As Assessed On Echocardiography Is Predictive Of Atrial Fibrillation Recurrence After Coronary Artery Bypass Surgery
Journal of cardiac failure ( IF 6 ) Pub Date : 2024-01-09 , DOI: 10.1016/j.cardfail.2023.10.134
Al-Ameen Oredegbe , Jeanwoo Yoo , Kyle Miller , Hafiza Waqar , John Tremblay , Zachary Kimball , George Tawfellos , Evan Adelstein , Mikhail Torosoff

Background

Atrial fibrillation (AF) and atrial flutter (AFL) are common after coronary artery bypass (CABG) surgery and are associated with significant morbidity. Assessed with echocardiogram left atrial function has been shown in various studies to be a marker of cardiovascular risk. Effects of left atrial size and function on post-CABG acute and recurrent atrial fibrillation were not well investigated.

Methods

This was a retrospective study involving 398 consecutive patients without prior AF/AFL and CHA2DS2VASC score > 1 for men or > 2 for women who underwent CABG without valvular surgery at a single tertiary academic center between 2020 and 2021. Pre-operative demographic, laboratory, and echocardiographic data and post-CABG outcomes were analyzed. Left atrial volumes including maximum left atrial volume as well as left atrial conduit, booster, and strain were obtained.

Results

Study cohort included 79 (19.8%) females, 64.9+/-9.2 years old, predominantly white (350, 87.9%), with DM in 210 (52.8%), lung disease in 62 (15.6%), and chronic kidney disease in 54 (13.6%). Post-CABG AF/AFL was noted in 36.2% (144/398), and recurrent AF/AFL after a first episode was noted in 49.3% (71/144). Hospital stay was longer in patients with post-CABG AF/AFL (13.9 +/- 7.2 vs 11.1 +/- 6.3 days, p < 0.001), and recurrent AF/AFL was associated with even longer hospital stay (14.6 +/- 8 vs 11.6 +/- 6.4 days, p < 0.007). Patients with recurrent AF/AFL had significantly larger maximal left atrial volumes (61.8+/-17.57 vs. 51.8+/-24.91, p = 0.009). Left atrial conduit (36.6+/-18.0 vs 35.1+/-22.7%, p =0.702), booster (27.7 +/-14.8 vs. 28.7+/-17.1%, p=0.73) and strain (34.6+/-18.0 vs. 35.8+/-23.9%, p=0.702) were similar in patients with and without AF/AFL recurrence. On multivariate analysis, increased left atrial volume (HR 1.024 per 1 ml, 95%CI 1.007-1.040, p<0.005) was significantly associated with post-CABG AF/AFL.

Conclusion

Post-CABG AF/AFL is common and leads to longer hospital stay after surgery. Maximum pre-CABG left atrial volume was associated with recurrence of atrial fibrillation and atrial flutter post-CABG.

中文翻译：

超声心动图评估的左心房肌病可预测冠状动脉搭桥手术后心房颤动的复发

背景

心房颤动 (AF) 和心房扑动 (AFL) 在冠状动脉搭桥 (CABG) 手术后很常见，并且与显着的发病率相关。多项研究表明，超声心动图评估的左心房功能是心血管风险的标志。左心房大小和功能对 CABG 后急性和复发性房颤的影响尚未得到充分研究。

方法

这是一项回顾性研究，涉及 2020 年至 2021 年间在单一三级学术中心接受 CABG 且未进行瓣膜手术的 398 名连续患者，这些患者既往无 AF/AFL，且 CHA2DS2VASC 评分男性 > 1，女性 > 2。并分析了超声心动图数据和冠状动脉搭桥术后的结果。获得左心房容积，包括最大左心房容积以及左心房导管、增强器和应变。

结果

研究队列包括 79 名 (19.8%) 女性，年龄 64.9+/-9.2 岁，主要是白人 (350 名，87.9%)，其中 210 名 (52.8%) 患有糖尿病，62 名 (15.6%) 患有肺部疾病，15 名患有慢性肾病54（13.6%）。CABG 后 AF/AFL 的发生率为 36.2% (144/398)，首次发作后复发 AF/AFL 的发生率为 49.3% (71/144)。CABG 后 AF/AFL 患者的住院时间较长（13.9 +/- 7.2 天 vs 11.1 +/- 6.3 天，p < 0.001），并且复发性 AF/AFL 与更长的住院时间相关（14.6 +/- 8） vs 11.6 +/- 6.4 天，p < 0.007）。复发性 AF/AFL 患者的最大左心房容积显着增大（61.8+/-17.57 vs. 51.8+/-24.91，p = 0.009）。左心房导管（36.6+/-18.0 vs 35.1+/-22.7%，p = 0.702）、增强型（27.7 +/-14.8 vs. 28.7+/-17.1%，p=0.73）和应变（34.6+/-18.0） vs. 35.8+/-23.9%，p=0.702）在有和没有 AF/AFL 复发的患者中相似。多变量分析显示，左心房容积增加（HR 1.024/1 ml，95% CI 1.007-1.040，p<0.005）与 CABG 后 AF/AFL 显着相关。