Nakamura Takeshi, Azuma Akihiro, Sawada Takahisa, Sakamoto Kenzo, Yamano Tetsuhiro, Yaku Hitoshi, Matsubara Hiroaki
Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Coron Artery Dis. 2007 Jun;18(4):253-8. doi: 10.1097/MCA.0b013e328089f1b4.
Postoperative atrial fibrillation is associated with the increased incidence of morbidities and mortality. Predisposing determinants of atrial fibrillation development after off-pump coronary artery bypass grafting remain unclear. We hypothesized that pericardial fluid natriuretic peptide concentrations have a predictive value for developing postoperative atrial fibrillation in patients who have undergone off-pump coronary artery bypass grafting.
We prospectively measured atrial natriuretic peptide and brain natriuretic peptide concentrations in plasma and pericardial fluid in 42 consecutive patients undergoing off-pump coronary artery bypass grafting, then continuously observed the occurrence of atrial fibrillation following off-pump coronary artery bypass grafting until the time of discharge.
Postoperative atrial fibrillation was documented in nine patients (21%, atrial fibrillation group), and not in 33 patients (no atrial fibrillation group). Between the groups, there was neither significant difference in plasma atrial natriuretic peptide concentrations nor in pericardial atrial natriuretic peptide concentrations. Plasma brain natriuretic peptide concentrations were comparable in both groups [56.2 (interquartile range 42.7-102.8) vs. 35.2 pg/ml (13.8-75.0), P=0.07]. Pericardial fluid brain natriuretic peptide concentrations were significantly higher in the atrial fibrillation group than in the no atrial fibrillation group [188.0 (124.8-411.0) vs. 39.3 pg/ml (10.0-88.4), P=0.0001]. In a multivariable logistic regression model, pericardial brain natriuretic peptide concentration was significantly associated with a higher risk of postoperative atrial fibrillation (odds ratio=3.0 every 50 pg/ml increase; 95% confidence interval, 1.1-8.6; P=0.04).
Our results suggested that pericardial fluid brain natriuretic peptide concentration is independently associated with the development of atrial fibrillation after off-pump coronary artery bypass grafting.
术后房颤与发病率和死亡率的增加相关。非体外循环冠状动脉搭桥术后房颤发生的易感决定因素仍不清楚。我们假设心包液利钠肽浓度对非体外循环冠状动脉搭桥术后发生房颤具有预测价值。
我们前瞻性地测量了42例连续接受非体外循环冠状动脉搭桥术患者血浆和心包液中的心房利钠肽和脑利钠肽浓度，然后持续观察非体外循环冠状动脉搭桥术后房颤的发生情况直至出院。
9例患者（21%，房颤组）记录到术后房颤，33例患者（无房颤组）未发生术后房颤。两组之间，血浆心房利钠肽浓度和心包房利钠肽浓度均无显著差异。两组血浆脑利钠肽浓度相当[56.2（四分位数间距42.7 - 102.8）对35.2 pg/ml（13.8 - 75.0），P = 0.07]。房颤组心包液脑利钠肽浓度显著高于无房颤组[188.0（124.8 - 411.0）对39.3 pg/ml（10.0 - 88.4），P = 0.0001]。在多变量逻辑回归模型中，心包脑利钠肽浓度与术后房颤风险较高显著相关（每增加50 pg/ml优势比 = 3.0；95%置信区间，1.1 - 8.6；P = 0.04）。
我们的结果表明，心包液脑利钠肽浓度与非体外循环冠状动脉搭桥术后房颤的发生独立相关。
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