Lu Rongxin, Ma Nan, Jiang Zhaolei, Mei Ju
Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Clin Cardiol. 2017 Nov;40(11):1100-1104. doi: 10.1002/clc.22783. Epub 2017 Aug 29.
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery and is associated with poorer prognosis. This study attempted to evaluate whether hemodynamic parameters determined by a right heart catheter predict the occurrence of POAF.
We hypothesized that atrial fibrillation after cardiac surgery can be predicted by hemodynamic parameters determined by a right heart catheter.
Between October 2015 and January 2017, 126 patients with preoperative sinus rhythm undergoing coronary artery bypass grafting and/or aortic valve replacement were enrolled in this study. Complete echocardiographic examination was performed preoperatively, and hemodynamic parameters were recorded via a right heart catheter before anesthesia induction. Postoperative telemetry strips and electrocardiogram were used to detect atrial fibrillation until discharge. Multivariate logistic regression was used to identify risk factors of POAF.
The overall incidence of POAF was 40/126 (31.7%). Multivariate logistic regression analysis determined that left atrial dimension (LAD) (adjusted odds ratio [OR]: 1.118, 95% confidence interval [CI]: 1.020-1.227, P = 0.018), pulmonary capillary wedge pressure (PCWP) (adjusted OR: 1.225, 95% CI: 1.082-1.387, P = 0.001), and pulmonary artery systolic pressure (PASP) (adjusted OR: 1.076, 95% CI: 1.019-1.137, P = 0.008) were significant predictors of POAF.
The present study suggested that LAD, PCWP, and PASP were robust predictors of POAF. These parameters may indicate a patient's susceptibility toward developing POAF and help to identify patients who need preventive treatment.
术后房颤（POAF）是心脏手术后常见的并发症，且与较差的预后相关。本研究旨在评估右心导管测定的血流动力学参数是否能预测POAF的发生。
我们假设心脏手术后的房颤可通过右心导管测定的血流动力学参数来预测。
2015年10月至2017年1月，126例术前窦性心律且接受冠状动脉旁路移植术和/或主动脉瓣置换术的患者纳入本研究。术前进行完整的超声心动图检查，并在麻醉诱导前通过右心导管记录血流动力学参数。术后采用遥测条和心电图检测房颤直至出院。采用多因素logistic回归分析确定POAF的危险因素。
POAF的总发生率为40/126（31.7%）。多因素logistic回归分析确定，左心房内径（LAD）（调整比值比[OR]：1.118，95%置信区间[CI]：1.020-1.227，P = 0.018）、肺毛细血管楔压（PCWP）（调整OR：1.225，95%CI：1.082-1.387，P = 0.001）和肺动脉收缩压（PASP）（调整OR：1.076，95%CI：1.019-1.137，P = 0.008）是POAF的显著预测因素。
本研究表明，LAD、PCWP和PASP是POAF的有力预测因素。这些参数可能表明患者发生POAF的易感性，并有助于识别需要预防性治疗的患者。
