Chua Su-Kiat, Shyu Kou-Gi, Lu Ming-Jen, Hung Huei-Fong, Cheng Jun-Jack, Chiu Chiung-Zuan, Lin Chia-Hsun, Chao Hung-Hsing, Lo Huey-Ming
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Rd., Shih-Lin District, Taipei, Taiwan Department of General Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wen Chang Rd., Shih-Lin District, Taipei, Taiwan.
Europace. 2015 Sep;17(9):1363-70. doi: 10.1093/europace/euu360. Epub 2015 Feb 5.
To investigate whether renal dysfunction is a useful predictor of postoperative atrial fibrillation (POAF) after cardiac surgery. We also aimed to determine whether the addition of renal dysfunction into the scoring system could improve diagnostic accuracy of the CHA2DS2-VASc score to predict POAF.
The study prospectively enrolled 350 consecutive patients who underwent cardiac surgery. Echocardiography was performed before cardiac surgery. Renal dysfunction was defined as estimated glomerular filtration rate < 60 mL min(-1) 1.73 m(-2). All patients were monitored with continuous electrocardiographic telemetry for the occurrence of POAF until the day of hospital dismissal. Postoperative atrial fibrillation occurred in 103 of 350 patients (29%). Patients with POAF was associated with longer intensive care unit stay compared with those without POAF (3.7 ± 2.2 vs. 3.1 ± 1.4 days, P = 0.002). Both the CHA2DS2-VASc score and renal dysfunction were independent predictors of POAF in multivariate analysis. Renal dysfunction can further stratify patients with a CHA2DS2-VASc score of 0 or 1 into two groups with different POAF rates (3.1% vs. 68.8%, P < 0.001). A new scoring system (R-CHA2DS2-VASc score) derived by assigning an additional point representing renal dysfunction to the CHA2DS2-VASc score could improve its predictive accuracy. The area under the receiver operating characteristic curve increased from 0.68 to 0.71 (P < 0.001). Furthermore, the rate of left ventricular diastolic dysfunction also increased with increasing renal dysfunction.
Renal dysfunction, associated with left ventricular diastolic dysfunction, was a significant risk factor for POAF after cardiac surgery and may improve the diagnostic accuracy of the CHA2DS2-VASc score.
研究肾功能不全是否是心脏手术后发生术后房颤（POAF）的有用预测指标。我们还旨在确定将肾功能不全纳入评分系统是否能提高CHA2DS2-VASc评分预测POAF的诊断准确性。
本研究前瞻性纳入了350例连续接受心脏手术的患者。在心脏手术前进行超声心动图检查。肾功能不全定义为估算肾小球滤过率<60 mL·min⁻¹·1.73 m⁻²。所有患者均通过连续心电遥测监测是否发生POAF，直至出院。350例患者中有103例（29%）发生了术后房颤。与未发生POAF的患者相比，发生POAF的患者重症监护病房住院时间更长（3.7±2.2天对3.1±1.4天，P = 0.002）。在多因素分析中，CHA2DS2-VASc评分和肾功能不全都是POAF的独立预测因素。肾功能不全可将CHA2DS2-VASc评分为0或1的患者进一步分为两组，POAF发生率不同（3.1%对68.8%，P<0.001）。通过给CHA2DS2-VASc评分增加一个代表肾功能不全的额外分数得出的新评分系统（R-CHA2DS2-VASc评分）可提高其预测准确性。受试者工作特征曲线下面积从0.68增加到0.71（P<0.001）。此外，左心室舒张功能障碍的发生率也随着肾功能不全程度的增加而升高。
与左心室舒张功能障碍相关的肾功能不全是心脏手术后发生POAF的重要危险因素，可能提高CHA2DS2-VASc评分的诊断准确性。
