Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Department of Anesthesiology, Medical University of Vienna, Vienna, Austria.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac275.
Postoperative atrial fibrillation (POAF) represents a common complication after cardiac surgery that is associated with unfavourable clinical outcome. Identifying patients at risk for POAF is crucial but challenging. This study aimed to investigate the prognostic potential of speckle-tracking echocardiography on POAF and fatal adverse events from a long-term perspective.
A total of 124 patients undergoing elective cardiac surgery were prospectively enrolled and underwent preoperative speckle-tracking echocardiography. Patients were followed prospectively for the occurrence of POAF within the entire hospitalization and reaching the secondary end points cardiovascular and all-cause mortality.
Within the study population 43.5% (n = 53) of enrolled individuals developed POAF. After a median follow-up of 3.9 years, 25 (20.2%) patients died. We observed that patients presenting with POAF had lower global peak atrial longitudinal strain (PALS) values compared to the non-POAF arm {POAF: 14.8% [95% confidence interval (CI): 10.9-17.8] vs non-POAF: 19.4% [95% CI: 14.8-23.5], P < 0.001}. Moreover, global PALS was a strong and independent predictor for POAF [adjusted odds ratio per 1 standard deviation: 0.37 (95% CI: 0.22-0.65), P < 0.001] and independently associated with mortality [adjusted hazard ratio per 1 standard deviation: 0.63 (95% CI: 0.40-0.99), P = 0.048]. Classification and Regression Tree analysis revealed a cut-off value of <17% global PALS as high risk for both POAF and mortality.
Global PALS is associated with the development of POAF following surgery in an unselected patient population undergoing CABG and/or valve surgery. Since patients with global PALS <17% face a poor long-term prognosis, routine assessment of global PALS needs to be considered in terms of proper secondary prevention in the era of personalized medicine.
术后心房颤动（POAF）是心脏手术后常见的并发症，与不良临床结局相关。识别 POAF 风险患者至关重要，但具有挑战性。本研究旨在从长期角度探讨斑点追踪超声心动图对 POAF 和致命不良事件的预测价值。
前瞻性纳入 124 例行择期心脏手术的患者，并进行术前斑点追踪超声心动图检查。前瞻性随访患者整个住院期间 POAF 的发生情况，并达到次要终点心血管和全因死亡率。
在研究人群中，43.5%（n=53）的患者发生 POAF。中位随访 3.9 年后，25 例（20.2%）患者死亡。我们观察到发生 POAF 的患者的整体峰值心房纵向应变（PALS）值低于非 POAF 组{POAF：14.8%[95%置信区间（CI）：10.9-17.8]比非 POAF：19.4%[95% CI：14.8-23.5]，P<0.001}。此外，整体 PALS 是 POAF 的强独立预测因子[每 1 个标准差调整后的优势比：0.37（95%CI：0.22-0.65），P<0.001]，并与死亡率独立相关[每 1 个标准差调整后的危险比：0.63（95%CI：0.40-0.99），P=0.048]。分类和回归树分析显示，<17%的整体 PALS 为 POAF 和死亡率的高风险。
在接受冠状动脉旁路移植术和/或瓣膜手术的未选择患者人群中，整体 PALS 与术后 POAF 的发生相关。由于 PALS <17%的患者长期预后较差，因此在个性化医学时代，需要考虑常规评估整体 PALS，以便进行适当的二级预防。
