Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Department of Anesthesiology, Medical University of Vienna, Vienna, Austria.
Thromb Haemost. 2021 Nov;121(11):1523-1529. doi: 10.1055/a-1400-6096. Epub 2021 Apr 14.
Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain; however, its prognostic potential on the development of POAF has not been investigated so far.
Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative mid-region proANP (MR-proANP) values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events.
A total of 138 individuals (43.9%) developed POAF. Median concentrations of MR-proANP were significantly higher within the POAF group ( < 0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per 1 standard deviation (1-SD; 95% confidence interval [CI]: 1.31-2.15; < 0.001), which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95% CI: 1.17-2.58; = 0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (0.23 [95% CI: 0.0349-0.4193]; = 0.022) and integrated discrimination increment (0.02 [95% CI: 0.0046-0.0397], = 0.013).
MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic preoperative work-up, a standardized preoperative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.
术后心房颤动（POAF）是心脏手术后常见的并发症，与主要不良事件和患者预后不良有关。目前用于这种心律失常风险分层的工具仍然很少。心房利钠肽（ANP）是一种易于评估的生物标志物，可反映心房功能和应变；然而，其在 POAF 发展中的预后潜力尚未得到研究。
本研究前瞻性纳入 314 例择期心脏手术患者。在手术干预前评估术前中段 proANP（MR-proANP）值。前瞻性随访和连续筛查心律失常事件的发生。
共有 138 人（43.9%）发生 POAF。POAF 组的 MR-proANP 中位数明显较高（ < 0.001）。MR-proANP 与 POAF 的发生有很强的关联，未经调整的比值比（OR）为每 1 个标准差（1-SD）增加 1.68（95%置信区间 [CI]：1.31-2.15； < 0.001），在综合调整混杂因素后，调整后的 OR 为每 1-SD 增加 1.74（95% CI：1.17-2.58； = 0.006）。MR-proANP 对 POAF 发生的预测能力通过无类别净重新分类改善（0.23 [95% CI：0.0349-0.4193]； = 0.022）和综合判别增量（0.02 [95% CI：0.0046-0.0397]， = 0.013）得到验证。
MR-proANP 是 POAF 发生的一个强有力的独立预测因子。考虑到个性化的诊断和预后术前评估，标准化的术前 MR-proANP 水平评估可能有助于识别心脏手术后发生 POAF 的高危患者。
