Department of Cardiology, Tepecik Training and Research Hospital, İzmir, Turkey.
J Surg Res. 2012 Nov;178(1):92-5. doi: 10.1016/j.jss.2012.01.051. Epub 2012 Apr 1.
Subclinical atrial stunning (AS) (left atrial dysfunction) may increase vulnerability to oxidative and inflammatory stressors, thus increasing the likelihood of postoperative supraventricular arrhythmias, especially atrial fibrillation (AF). Evaluation of mitral annular velocities by tissue Doppler imaging (TDI) may be useful in seeking subclinical AS. This prospective study aimed to evaluate the relationship between atrial fibrillation after bypass surgery and presurgical determination of subclinical AS by assessing mitral annular velocities by TDI.
We enrolled patients who underwent coronary artery bypass graft (CABG) surgery into this prospective study. Inclusion criteria were sinus rhythm and a negative history of atrial tachycardia during the previous 3 mo. An experienced cardiologist performed transthoracic echocardiography in all patients. We recorded standard two-dimensional, mitral inflow conventional Doppler interrogation and TDI pulsed wave data from the lateral and septal annulus. All patients underwent CABG surgery at our Cardiovascular Surgery Unit. Patients were divided into two groups based on their postoperative AF status: group 1 patients had postoperative AF and group 2 patients did not.
This study included 44 patients. Age and the presence of chronic obstructive pulmonary disease were the only two significantly different parameters among clinical characteristics between groups. Echocardiographic findings that were statistically significantly different between groups were as follows: lateral A diastolic mitral annular velocity, group 1: 0.11 ± 0.19 ms(-1)versus group 2: 0.08 ± 0.19 ms(-1) (P = 0.001); lateral E diastolic mitral annular velocity, group 1: 0.69 ± 0.24 ms(-1)versus group 2: 0.62 ± 0.31 ms(-1) (P = 0.016); Septal E diastolic mitral annular velocity, group 1: 0.05 ± 0.01 ms(-1)versus group 2: 0.04 ± 0.01 ms(-1) (P = 0.033); septal A diastolic mitral annular velocity, group 1: 0.08 ± 0.02 ms(-1)versus group 2: 0.05 ± 0.02 ms(-1) (P = 0.005).
There is no relationship between AF after CABG surgery and preexisting subclinical AS determined with mitral annular velocities by TDI. Preoperative appropriate prophylactic treatment should be administered to all patients.
亚临床左房顿抑（左房功能障碍）可能会增加对氧化和炎症应激源的易感性，从而增加术后房性心律失常的可能性，尤其是心房颤动（AF）。组织多普勒成像（TDI）评估二尖瓣环速度可能有助于寻找亚临床 AS。本前瞻性研究旨在通过 TDI 评估二尖瓣环速度来评估旁路手术后心房颤动与术前亚临床 AS 之间的关系。
我们将接受冠状动脉旁路移植（CABG）手术的患者纳入本前瞻性研究。纳入标准为窦性心律和前 3 个月内无房性心动过速史。所有患者均由经验丰富的心脏病专家进行经胸超声心动图检查。我们记录了标准的二维、二尖瓣流入常规多普勒检查和 TDI 脉冲波数据来自外侧和间隔环。所有患者均在我院心血管外科进行 CABG 手术。根据术后 AF 状态将患者分为两组：组 1 患者术后出现 AF，组 2 患者未出现 AF。
本研究共纳入 44 例患者。年龄和慢性阻塞性肺疾病的存在是两组间临床特征中唯一两个显著不同的参数。组间统计学差异的超声心动图发现如下：外侧 A 舒张期二尖瓣环速度，组 1：0.11±0.19ms(-1)vs 组 2：0.08±0.19ms(-1)(P=0.001)；外侧 E 舒张期二尖瓣环速度，组 1：0.69±0.24ms(-1)vs 组 2：0.62±0.31ms(-1)(P=0.016)；间隔 E 舒张期二尖瓣环速度，组 1：0.05±0.01ms(-1)vs 组 2：0.04±0.01ms(-1)(P=0.033)；间隔 A 舒张期二尖瓣环速度，组 1：0.08±0.02ms(-1)vs 组 2：0.05±0.02ms(-1)(P=0.005)。
CABG 手术后 AF 与 TDI 测定的二尖瓣环速度预存亚临床 AS 之间无相关性。应给予所有患者术前适当的预防治疗。
