Benedetto Umberto, Melina Giovanni, Roscitano Antonino, Ciavarella Giuseppe M, Tonelli Euclide, Sinatra Riccardo
Division of Cardiac Surgery, Ospedale Sant'Andrea, University of Rome La Sapienza, Rome, Italy.
Ann Thorac Surg. 2007 Jan;83(1):83-8. doi: 10.1016/j.athoracsur.2006.08.038.
Atrial systolic dysfunction in patients with coronary artery disease might influence the development of atrial fibrillation after coronary artery bypass grafting (CABG). Tissue Doppler imaging of the mitral annulus during atrial systole has proved to quantify, accurately, left atrial contractile function. Therefore, the aim of the present study was to investigate the correlation between preoperative left atrial dysfunction assessed by tissue Doppler and postoperative atrial fibrillation after CABG.
We studied a total of 96 patients (mean age 67 +/- 6 years; range, 55 to 81) undergoing CABG who were preoperatively in sinus rhythm. All patients underwent a preoperative transthoracic echocardiography with tissue Doppler evaluation. Until the day of discharge, all patients were monitored with continuous electrocardiographic telemetry.
There were no hospital deaths. Postoperative atrial fibrillation was recorded in 24 of 96 patients (25%). Patients with postoperative atrial fibrillation were significantly older (70 +/- 6 vs 65 +/- 8 years; p = 0.006), had a preoperative larger left atrium diameter (38 +/- 5 vs 36 +/- 4 mm; p = 0.045), a larger left atrium area (13.2 +/- 3.4 vs 11.5 +/- 2.3 cm2; p = 0.007), and a lower peak atrial systolic mitral annular tissue Doppler velocity (10 +/- 3 vs 13 +/- 5 cm/second; p = 0.01). Stepwise logistic regression analysis showed that age 70 years or greater (p = 0.02; odds ratio [OR] 2.0), preoperative medication with beta-blockers (p = 0.04; OR 0.7), left atrium area 13 cm2 or greater (p = 0.02; OR 2.5), and peak atrial systolic mitral annular tissue Doppler velocity 9 cm/second or less (p = 0.03; OR 1.8) were independently related with the incidence of postoperative atrial fibrillation.
Tissue Doppler is useful for assessing preoperative atrial dysfunction and predicting atrial fibrillation after CABG. Further studies are needed to confirm this finding.
冠心病患者的心房收缩功能障碍可能会影响冠状动脉旁路移植术（CABG）后房颤的发生。心房收缩期二尖瓣环的组织多普勒成像已被证明能准确量化左心房收缩功能。因此，本研究的目的是探讨通过组织多普勒评估的术前左心房功能障碍与CABG术后房颤之间的相关性。
我们共研究了96例接受CABG且术前为窦性心律的患者（平均年龄67±6岁；范围55至81岁）。所有患者均接受了术前经胸超声心动图检查及组织多普勒评估。直至出院日，所有患者均通过连续心电图遥测进行监测。
无院内死亡病例。96例患者中有24例（25%）记录到术后房颤。术后发生房颤的患者年龄显著更大（70±6岁 vs 65±8岁；p = 0.006），术前左心房直径更大（38±5 mm vs 36±4 mm；p = 0.045），左心房面积更大（13.2±3.4 cm² vs 11.5±2.3 cm²；p = 0.007），且心房收缩期二尖瓣环组织多普勒峰值速度更低（-10±3 cm/秒 vs 13±5 cm/秒；p = 0.01）。逐步逻辑回归分析显示，年龄70岁及以上（p = 0.02；比值比[OR] 2.0）、术前使用β受体阻滞剂（p =
0.04；OR 0.7）、左心房面积13 cm²及以上（p = 0.02；OR 2.5）以及心房收缩期二尖瓣环组织多普勒峰值速度9 cm/秒及以下（p = 0.03；OR 1.8）与术后房颤的发生率独立相关。
组织多普勒有助于评估术前心房功能障碍并预测CABG术后房颤。需要进一步研究来证实这一发现。
