1 CHU Limoges, Hôpital Dupuytren, Service Cardiologie, France.
2 INSERM 1094, Faculté de médecine de Limoges, France.
Eur Heart J Acute Cardiovasc Care. 2019 Mar;8(2):104-113. doi: 10.1177/2048872616688419. Epub 2017 Jan 6.
: Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation.
: We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min.
: Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older ( p=0.008), had more frequently a history of hypertension ( p=0.009), history of atrial fibrillation ( p<0.001) and New York Heart Association class ⩾III ( p=0.004). They also had longer PR interval ( p=0.005), higher preoperative NT-pro brain natriuretic peptide level ( p=0.006), left ventricle end-diastolic volume ( p=0.002), indexed left ventricle mass ( p<0.0001), indexed maximal left atrial volume ( p<0.0001), maximal right atrial area ( p<0.001) and lower left ventricle ejection fraction ( p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4-26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1-1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ) of the model, from 34 to 57.
: A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.
术后心房颤动是冠状动脉旁路移植术后的主要并发症。我们假设，除了临床和心电图（ECG）数据外，经胸超声心动图可以提高对术后心房颤动的预测能力。
我们前瞻性研究了 169 例在我院接受单纯冠状动脉旁路移植术且窦性心律的患者。在手术前 24 小时内收集临床、生物学、ECG 和经胸超声心动图数据。患者在术后的前 5 天内进行连续监测，然后每天进行 12 导联心电图检查，直到出院。术后心房颤动定义为任何 >10 分钟的发作。
65 例（38%）患者出现术后心房颤动。与无术后心房颤动的患者相比，术后心房颤动患者年龄明显更大（p=0.008），高血压病史（p=0.009）、心房颤动病史（p<0.001）和纽约心脏协会（NYHA）分级 ⩾III 级（p=0.004）更为常见。他们的 PR 间期也更长（p=0.005），术前 NT-pro 脑利钠肽水平更高（p=0.006），左心室舒张末期容积更大（p=0.002），左心室质量指数更高（p<0.0001），最大左心房容积指数更高（p<0.0001），右心房最大面积更大（p<0.001），左心室射血分数更低（p=0.04）。多变量分析显示，心房颤动病史（比值比=6.1，95%置信区间：1.4-26.0，p=0.02）和最大左心房容积指数（比值比=1.13，95%置信区间：1.1-1.2，p=0.001）是术后心房颤动的唯一两个独立预测因素。超声心动图参数的加入提高了模型的预测价值（χ），从 34 提高到 57。
心房颤动病史和左心房最大容积指数是冠状动脉旁路移植术后发生术后心房颤动的最佳预测因素。使用这两个因素识别术后心房颤动高危人群，可能会导致针对这些患者的针对性策略的制定，以限制这种常见并发症的发生。
