Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University.
Circ J. 2013;77(9):2303-10. Epub 2013 Jun 15.
Renal dysfunction is associated with a higher rate of atrial fibrillation in clinical practice. This study investigated the associations between renal function, left ventricular (LV) diastolic dysfunction, and postoperative atrial fibrillation (POAF).
A total of 265 consecutive patients who underwent cardiac surgery were prospectively enrolled in the study. Echocardiography was performed before cardiac surgery. The patients were divided into 3 groups based on estimated glomerular filtration rate (eGFR) (group 1, ≥90ml·min(-1)·1.73m(-2); group 2, 60-90ml·min(-1)·1.73m(-2); and group 3, <60ml·min(-1)·1.73m(-2)). POAF occurred in 83 of 265 patients (31.3%). The rate of new-onset POAF increased from 15.2% (12/79) in group 1 to 27.8% (27/97) in group 2 and 49.4% (44/89) in group 3 (P<0.001). Further, with increasing renal dysfunction from groups 1 to 3, the rate of LV diastolic dysfunction - defined as E/e' >15 - also increased (group 1, 19.0%; group 2, 38.1%; and group 3, 48.3%; P<0.001). Absolute eGFR was significantly correlated with E/e' ratio (r=-0.39, P<0.001). Renal function remained as the independent predictor of POAF on multivariate analysis (odds ratio, 1.90; 95% confidence interval: 1.26-2.87; P=0.002).
In patients undergoing cardiac surgery, decreased eGFR was associated with an increased rate of LV diastolic dysfunction with a subsequent increase in the rate of POAF.
肾功能障碍与临床实践中心律失常的发生率较高有关。本研究调查了肾功能、左心室（LV）舒张功能障碍与术后心房颤动（POAF）之间的关系。
共前瞻性纳入 265 例接受心脏手术的连续患者进行研究。心脏手术前进行超声心动图检查。根据估算肾小球滤过率（eGFR）将患者分为 3 组（组 1，≥90ml·min-1·1.73m-2；组 2，60-90ml·min-1·1.73m-2；组 3，<60ml·min-1·1.73m-2）。265 例患者中 83 例（31.3%）发生新发 POAF。新发 POAF 发生率从组 1 的 15.2%（12/79）增加到组 2 的 27.8%（27/97）和组 3 的 49.4%（44/89）（P<0.001）。进一步的，随着肾功能障碍从组 1 到组 3 的加重，LV 舒张功能障碍（定义为 E/e' >15）的发生率也增加（组 1，19.0%；组 2，38.1%；组 3，48.3%；P<0.001）。绝对 eGFR 与 E/e' 比值显著相关（r=-0.39，P<0.001）。多变量分析显示，肾功能仍然是 POAF 的独立预测因素（优势比，1.90；95%置信区间：1.26-2.87；P=0.002）。
在接受心脏手术的患者中，eGFR 降低与 LV 舒张功能障碍发生率增加相关，进而 POAF 发生率增加。
