Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University, Chuncheon, Republic of Korea.
Can J Cardiol. 2013 Mar;29(3):377-83. doi: 10.1016/j.cjca.2012.06.006. Epub 2012 Aug 15.
Left atrial (LA) dysfunction was recently proposed as an important factor in the development of postoperative atrial fibrillation (POAF). LA strain analysis by 2-dimensional (2D) speckle tracking imaging is emerging as a new tool to evaluate LA function. We aimed to evaluate the correlation of LA dysfunction assessed by 2D speckle tracking imaging with the occurrence of POAF after coronary artery bypass grafting (CABG).
In this study, 53 patients (mean age 66 ± 9 years) undergoing elective isolated CABG were enrolled. Conventional transthoracic echocardiography and 2D speckle tracking strain analysis were performed before surgery. POAF was detected with continuous electrocardiography monitoring throughout hospitalization (mean duration 17 ± 10 days).
POAF occurred in 13 of 53 patients (24%). Patients with POAF were significantly older than patients with normal sinus rhythm after surgery (71 ± 5 vs 64 ± 10 years, P = 0.026). Compared with patients with normal sinus rhythm, patients with POAF had a significantly larger LA volume index (32.6 ± 5.1 vs 27.3 ± 7.2 mL/m(2), P = 0.018), lower value of LA global strain (25.4 ± 10.4 vs 36.8 ± 7.6%, P = 0.001), and strain rate (1.2 ± 0.6 vs 1.6 ± 0.8 seconds, P = 0.024). By multivariate logistic regression analysis, only LA global strain (odds ratio, 1.12; 95% confidence interval, 1.00-1.24; P = 0.040) was an independent predictor of POAF after CABG.
Preoperative LA global strain measured by 2D speckle tracking strain analysis is associated with the development of POAF after CABG.
左心房（LA）功能障碍最近被提出是术后心房颤动（POAF）发展的一个重要因素。二维（2D）斑点追踪成像的 LA 应变分析正成为评估 LA 功能的新工具。我们旨在评估 2D 斑点追踪成像评估的 LA 功能障碍与冠状动脉旁路移植术（CABG）后 POAF 的发生之间的相关性。
本研究纳入了 53 例行择期 CABG 的患者（平均年龄 66 ± 9 岁）。术前进行常规经胸超声心动图和 2D 斑点追踪应变分析。通过连续心电图监测在整个住院期间（平均持续时间 17 ± 10 天）检测 POAF。
53 例患者中有 13 例（24%）发生 POAF。POAF 患者术后明显比窦性节律患者年龄大（71 ± 5 岁 vs 64 ± 10 岁，P = 0.026）。与窦性节律患者相比，POAF 患者的左房容积指数明显更大（32.6 ± 5.1 vs 27.3 ± 7.2 mL/m2，P = 0.018），左房整体应变值更低（25.4 ± 10.4 vs 36.8 ± 7.6%，P = 0.001），应变率也更低（1.2 ± 0.6 vs 1.6 ± 0.8 秒，P = 0.024）。多变量 logistic 回归分析显示，只有 LA 整体应变（比值比，1.12；95%置信区间，1.00-1.24；P = 0.040）是 CABG 后 POAF 的独立预测因素。
二维斑点追踪应变分析测量的术前 LA 整体应变与 CABG 后 POAF 的发生相关。
