冠状动脉搭桥手术后，左心房功能与大小在预测房颤方面的相对重要性。

The relative importance of left atrial function versus dimension in predicting atrial fibrillation after coronary artery bypass graft surgery.

作者信息

Nakai Toshiko, Lee Randall J, Schiller Nelson B, Bellows Wayne H, Dzankic Samir, Reeves John, Romson Joseph, Ferguson Scott, Leung Jacqueline M

机构信息

Department of Medicine, Section of Cardiac Electrophysiology, and Cardiovascular Research Institute, University of California, San Francisco 94143, USA.

出版信息

Am Heart J. 2002 Jan;143(1):181-6. doi: 10.1067/mhj.2002.120294.

DOI:10.1067/mhj.2002.120294

PMID:11773931

Abstract

BACKGROUND

Atrial fibrillation (AF) is a common complication after coronary artery bypass graft (CABG) surgery. The purpose of this study was to determine whether pre-existing left atrial dysfunction is a predictor of postoperative AF compared with other clinical predictors.

METHODS

Ninety-three patients undergoing CABG were prospectively studied. Intraoperatively, transesophageal echocardiography was performed to measure left atrial size, transmitral flow velocity, and other routine parameters. Left atrial function was estimated by the following formula: Atrial index = Transmitral VTI total x LAEF/Left atrial maximal area (where VTI = velocity time integral of E and A waves, LAEF = left atrial ejection fraction). The association of potential clinical predictors with the occurrence of postoperative AF was evaluated by chi2 or Fisher exact tests, followed by stepwise multivariate logistic regression model. P values and odds ratios (OR) with 95% CIs were reported. Significance was set at P <.05.

RESULTS

Postoperative AF occurred in 28 of 93 patients (30.1%). Patients with postoperative AF were older (67.0 +/- 8.3 vs 61.5 +/- 9.6 years, P =.0075), had larger left atrial maximal area (14.3 +/- 4.6 cm(2) vs 10.9 +/- 4.3 cm2, P <.001), lower atrial index (0.54 +/- 0.56 vs 0.82 +/- 0.64, P =.008), larger body surface area (BSA) (OR 57, 95% CI 3.97-827), longer aortic cross-clamp time (OR 1.03, 95% CI 1.00-1.05), and more likely to have a postoperative myocardial infarction (OR 3.28, 95% CI 0.99-10.87) compared with those without AF. By multivariate analysis, only age (OR 1.11, 95% CI 1.04-1.19, P =.002) and atrial dimension (OR 1.75, 95% CI 1.03-2.96, P =.038) were significant independent predictors of postoperative AF. Body surface area also increased the odds of postoperative AF, but the CI was wide (OR 114, 95% CI 4.65-2810, P =.004).

CONCLUSIONS

Our results demonstrate that age and atrial enlargement, rather than atrial function, were independent predictors of postoperative AF.

摘要

背景

心房颤动（AF）是冠状动脉旁路移植术（CABG）后常见的并发症。本研究的目的是确定与其他临床预测因素相比，术前存在的左心房功能障碍是否为术后房颤的预测因素。

方法

对93例行CABG手术的患者进行前瞻性研究。术中，行经食管超声心动图检查以测量左心房大小、二尖瓣血流速度及其他常规参数。通过以下公式估算左心房功能：心房指数=二尖瓣VTI总和×左心房射血分数/左心房最大面积（其中VTI = E波和A波的速度时间积分，LAEF =左心房射血分数）。通过卡方检验或Fisher精确检验评估潜在临床预测因素与术后房颤发生的相关性，随后进行逐步多因素逻辑回归模型分析。报告P值和95%置信区间的比值比（OR）。设定P <.05为有统计学意义。

结果

93例患者中有28例（30.1%）发生术后房颤。发生术后房颤的患者年龄较大（67.0±8.3岁 vs 61.5±9.6岁，P =.0075），左心房最大面积较大（14.3±4.6 cm² vs 10.9±4.3 cm²，P <.001），心房指数较低（0.54±0.56 vs 0.82±0.64，P =.008），体表面积（BSA）较大（OR 57，95% CI 3.97 - 827），主动脉阻断时间较长（OR 1.03，95% CI 1.00 - 1.05），与未发生房颤的患者相比，术后发生心肌梗死可能性更大（OR 3.28，95% CI 0.99 - 10.87）。多因素分析显示，只有年龄（OR 1.11，95% CI 1.04 - 1.19，P =.002）和心房大小（OR 1.75，95% CI 1.03 - 2.96，P =.038）是术后房颤的显著独立预测因素。体表面积也增加了术后房颤的发生几率，但置信区间较宽（OR 114，95% CI 4.65 - 2810，P =.004）。