Osranek Martin, Fatema Kaniz, Qaddoura Fatema, Al-Saileek Ahmed, Barnes Marion E, Bailey Kent R, Gersh Bernard J, Tsang Teresa S M, Zehr Kenton J, Seward James B
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Am Coll Cardiol. 2006 Aug 15;48(4):779-86. doi: 10.1016/j.jacc.2006.03.054. Epub 2006 Jul 25.
This study sought to identify preoperative predictors of postoperative atrial fibrillation (POAF) among patients undergoing cardiac surgery.
Postoperative atrial fibrillation is frequent after cardiac surgery and is associated with increased morbidity, mortality, prolonged hospital stay, and increased costs. Left atrial volume (LAV), a marker of chronically elevated left ventricular filling pressure, is a predictor of atrial fibrillation (AF) in the nonsurgical setting.
A total of 205 patients (mean age 62 +/- 16 years; 35% women) undergoing cardiac surgery were prospectively enrolled. Clinical risk factors were obtained by detailed medical record review and patient interview. Preoperative transthoracic echocardiograms were performed for assessment of LAV, left ventricular ejection fraction, and diastolic function. Follow-up was complete. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization.
Postoperative atrial fibrillation occurred in 84 patients (41.4%) at a median of 1.8 days after cardiac surgery. The LAV was significantly larger in patients in whom AF developed (49 +/- 14 ml/m2 vs. 39 +/- 16 ml/m2, p = 0.0001). Patients with LAV >32 ml/m2 had an almost five-fold increased risk of POAF, independently of age and clinical risk factors (adjusted hazard ratio 4.84, 95% confidence interval 1.93 to 12.17, p = 0.001). Age and LAV were the only independent predictors of POAF. The area under the receiver-operator characteristics curve to predict POAF was 0.729 for LAV and 0.768 for the combination of LAV and age (both p < 0.0001).
The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.
本研究旨在确定心脏手术患者术后房颤（POAF）的术前预测因素。
心脏手术后术后房颤很常见，且与发病率增加、死亡率增加、住院时间延长及费用增加相关。左心房容积（LAV）是慢性左心室充盈压升高的一个指标，在非手术情况下是房颤（AF）的一个预测因素。
前瞻性纳入了总共205例接受心脏手术的患者（平均年龄62±16岁；35%为女性）。通过详细查阅病历和患者访谈获取临床危险因素。术前行经胸超声心动图检查以评估LAV、左心室射血分数和舒张功能。随访完整。POAF的检测基于住院期间通过连续遥测记录的房颤发作情况。
84例患者（41.4%）术后发生房颤，中位时间为心脏手术后1.8天。发生房颤的患者LAV明显更大（49±14 ml/m² 对39±16 ml/m²，p = 0.0001）。LAV>32 ml/m² 的患者发生POAF的风险几乎增加了五倍，与年龄和临床危险因素无关（调整后风险比4.84，95%置信区间1.93至12.17，p = 0.001）。年龄和LAV是POAF仅有的独立预测因素。预测POAF的受试者工作特征曲线下面积，LAV为0.729，LAV与年龄联合为0.768（两者p<0.0001）。
LAV是POAF强有力的独立预测因素。使用LAV和年龄进行风险分层可使临床医生在心脏手术前识别高危患者。
