Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Karegar Shomali Street, Tehran, Islamic Republic of Iran.
BMC Cardiovasc Disord. 2021 Feb 16;21(1):94. doi: 10.1186/s12872-021-01908-8.
The CHADS-VASc scoring system is correlated with left atrial (LA) reservoir function in patients with atrial fibrillation (AF) rhythm or paroxysmal AF. We assessed the ability of CHADS-VASc to grade LA function in patients with sinus rhythm who were candidates for coronary artery bypass grafting (CABG).
This cross-sectional study recruited 340 consecutive candidates for CABG and categorized them according to their CHADS-VASc scores as mild-, moderate-, and high-risk score groups with 34 (10%), 83 (24%), and 223 (66%) patients, respectively. LA function was evaluated via 2D speckle-tracking echocardiography in terms of global longitudinal strain and strain rate during the reservoir, conduit, and contraction phases. In-hospital mortality, postoperative AF, prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation were assessed.
LA strain and strain rate during the reservoir phase was statistically significantly lower in the high-risk score group than the low- and moderate-risk score groups (27.8 ± 6.9% vs 31.0 ± 5.0% vs 29.8 ± 6.1%, respectively; P = 0.004 and 2.6 ± 0.7 s vs 2.9 ± 0.6 s vs 2.9 ± 0.6 s, correspondingly; P = 0.009) and regarding LA strain and strain rate during the conduit phase (9.7 [7.1-12.5]% vs 12.9 [9.4-15.1]% vs 11.5 [9.1-13.8]%, correspondingly; P < 0.001 and 2.1 [1.6-2.7] s vs 2.8 [2.4-3.6] s vs 2.6 [2.2-3.0] s, respectively; P < 0.001). In addition, LA strain rate during the conduit phase was lower in the moderate-risk score group than the low-risk score group. After adjustments for possible confounders, these differences remained statistically significant. The risk of postoperative AF and prolonged ICU stay was highest in the high-risk score group (relative risk = 9.67 (1.31-71.43) and 8.05 (1.08-60.16), respectively; P = 0.026 and P = 0.042, respectively).
LA reservoir and conduit functions decreased in the high-risk score group, which was accompanied by an increased risk of postoperative AF and prolonged ICU stay.
CHADS-VASc 评分系统与心房颤动（AF）节律或阵发性 AF 患者的左心房（LA）储备功能相关。我们评估了 CHADS-VASc 在窦性心律且候选冠状动脉旁路移植术（CABG）的患者中分级 LA 功能的能力。
这项横断面研究纳入了 340 例连续候选 CABG 的患者，并根据 CHADS-VASc 评分将其分为轻度、中度和高危评分组，每组分别有 34 例（10%）、83 例（24%）和 223 例（66%）患者。通过二维斑点追踪超声心动图评估 LA 功能，评估指标包括储存期、传导期和收缩期的整体纵向应变和应变率。评估住院死亡率、术后 AF、延长 ICU 住院时间和延长机械通气时间。
高危评分组的 LA 应变和储存期应变率明显低于低危和中危评分组（分别为 27.8±6.9%、31.0±5.0%和 29.8±6.1%；P=0.004 和 2.6±0.7 s、2.9±0.6 s 和 2.9±0.6 s；P=0.009）和 LA 应变和传导期应变率（分别为 9.7[7.1-12.5]%、12.9[9.4-15.1]%和 11.5[9.1-13.8]%；P<0.001 和 2.1[1.6-2.7]s、2.8[2.4-3.6]s 和 2.6[2.2-3.0]s；P<0.001）。此外，中危评分组的 LA 传导期应变率低于低危评分组。在调整了可能的混杂因素后，这些差异仍然具有统计学意义。高危评分组的术后 AF 和 ICU 住院时间延长的风险最高（相对风险分别为 9.67（1.31-71.43）和 8.05（1.08-60.16）；P=0.026 和 P=0.042）。
高危评分组的 LA 储备和传导功能下降，同时术后 AF 和 ICU 住院时间延长的风险增加。
