Yin Liang, Ling Xinyu, Zhang Yufeng, Shen Hua, Min Jie, Xi Wang, Wang Jing, Wang Zhinong
Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
PLoS One. 2015 Apr 7;10(4):e0123858. doi: 10.1371/journal.pone.0123858. eCollection 2015.
Clinical use of CHADS2 and CHA2DS2-VASc scoring systems for predicting AF following cardiac surgery have been reported in previous studies and demonstrated well-validated predictive value. We sought to investigate whether the two scoring systems are effective for predicting new-onset of AF following cardiac valve surgery and to demonstrate its potential utility of clinical assessment.
Medical records of all patients underwent cardiac valve surgeries during the period of January 2003 and December 2013 without preoperative AF at the cardiac center of our university were reviewed. The main outcome end point of our study was the early new-onset of AF following cardiac valve surgery.
There were overall 518 patients involved in this study, with 234 (45.17%) developed POAF following valve surgery. Patients with POAF had older age (P=0.23) and higher BMI (P=0.013) than those without POAF. History of heart failure (P=0.025), hypertension (P=0.021), previous stroke or TIA (P=0.032), coronary artery disease (P=0.001), carotid artery disease (P=0.024) and preoperative medication of statins (P=0.021) were significantly more recorded in POAF group. Patients with POAF also had higher LAD (P=0.013) and E/e' ratio (P<0.001). The CHADS2 and CHA2DS2-VASc scores were significantly higher in patients with POAF (P=0.002; P<0.001), and under univariate and multivariate regression analysis the CHADS2 and CHA2DS2-VASc scores were significant predictors of POAF (P=0.001; P<0.001). Based on stratification of CHADS2 and CHA2DS2-VASc scores, the Kaplan-Meier analysis obtained a higher POAF rate on patients with higher stratification of CHADS2 and CHA2DS2-VASc scores (P<0.001; P<0.001).
In conclusion, CHADS2 and CHA2DS2-VASc scores were directly associated with the incidence of POAF following valve surgery and a higher score was strongly predictive of POAF.
既往研究已报道CHADS2和CHA2DS2-VASc评分系统在预测心脏手术后房颤方面的临床应用，并证实其具有良好验证的预测价值。我们旨在研究这两种评分系统对预测心脏瓣膜手术后新发房颤是否有效，并证明其在临床评估中的潜在效用。
回顾了2003年1月至2013年12月期间在我校心脏中心接受心脏瓣膜手术且术前无房颤的所有患者的病历。本研究的主要结局终点是心脏瓣膜手术后早期新发房颤。
本研究共纳入518例患者，其中234例（45.17%）在瓣膜手术后发生术后房颤（POAF）。POAF患者的年龄（P=0.23）和体重指数（BMI）（P=0.013）高于未发生POAF的患者。POAF组记录到心力衰竭病史（P=0.025）、高血压病史（P=0.021）、既往卒中或短暂性脑缺血发作（TIA）病史（P=0.032）、冠状动脉疾病（P=0.001）、颈动脉疾病（P=0.024）及术前使用他汀类药物（P=0.021）的比例显著更高。POAF患者的左心房内径（LAD）（P=0.013）和E/e'比值（P<0.001）也更高。POAF患者的CHADS2和CHA2DS2-VASc评分显著更高（P=0.002；P<0.001），单因素和多因素回归分析显示CHADS2和CHA2DS2-VASc评分是POAF的显著预测因素（P=0.001；P<0.001）。基于CHADS2和CHA2DS2-VASc评分分层，Kaplan-Meier分析显示CHADS2和CHA2DS2-VASc评分分层较高的患者POAF发生率更高（P<0.001；P<0.001）。
总之，CHADS2和CHA2DS2-VASc评分与瓣膜手术后POAF的发生率直接相关，评分越高，POAF的预测性越强。
