Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
Department of Intensive Care Medicine, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia.
Heart Rhythm. 2022 Nov;19(11):1774-1780. doi: 10.1016/j.hrthm.2022.06.019. Epub 2022 Jun 17.
Postoperative atrial fibrillation (POAF) is a frequent complication after heart surgery and is associated with thromboembolic events, prolonged hospital stay, and adverse outcomes. Inflammation and fibrosis are involved in the pathogenesis of atrial fibrillation.
The purpose of this study was to assess whether galectin-3, which reflects preexisting atrial fibrosis, has the potential to predict POAF and mortality after cardiac surgery.
Four hundred seventy-five consecutive patients (mean age 67.4 ± 11.8 years; 336 (70.7%) male) undergoing elective heart surgery at the Medical University of Vienna were included in this prospective single-center cohort study. Galectin-3 plasma levels were assessed on the day before surgery.
The 200 patients (42.1%) who developed POAF had significantly higher galectin-3 levels (9.60 ± 6.83 ng/mL vs 7.10 ± 3.54 ng/mL; P < .001). Galectin-3 significantly predicted POAF in multivariable logistic regression analysis (adjusted odds ratio per 1-SD increase 1.44; 95% confidence interval 1.15-1.81; P = .002). During a median follow-up of 4.3 years (interquartile range 3.4-5.4 years), 72 patients (15.2%) died. Galectin-3 predicted all-cause mortality in multivariable Cox regression analysis (adjusted hazard ratio per 1-SD increase 1.56; 95% confidence interval 1.16-2.09; P = .003). Patients with the highest-risk galectin-3 levels according to classification and regression tree analysis (>11.70 ng/mL) had a 3.3-fold higher risk of developing POAF and a 4.4-fold higher risk of dying than did patients with the lowest-risk levels (≤5.82 ng/mL).
The profibrotic biomarker galectin-3 is an independent predictor of POAF and mortality after cardiac surgery. This finding highlights the role of the underlying arrhythmogenic substrate in the genesis of POAF. Galectin-3 may help to identify patients at risk of POAF and adverse outcome after cardiac surgery.
术后心房颤动（POAF）是心脏手术后的常见并发症，与血栓栓塞事件、住院时间延长和不良结局有关。炎症和纤维化参与了心房颤动的发病机制。
本研究旨在评估反映预先存在的心房纤维化的半乳糖凝集素-3 是否有可能预测心脏手术后的 POAF 和死亡率。
本前瞻性单中心队列研究纳入了在维也纳医科大学接受择期心脏手术的 475 例连续患者（平均年龄 67.4 ± 11.8 岁；336 例[70.7%]为男性）。在手术前一天评估半乳糖凝集素-3 的血浆水平。
发生 POAF 的 200 例患者（42.1%）的半乳糖凝集素-3 水平显著升高（9.60 ± 6.83 ng/mL 比 7.10 ± 3.54 ng/mL；P <.001）。在多变量逻辑回归分析中，半乳糖凝集素-3 显著预测 POAF（每增加 1-SD 的调整优势比为 1.44；95%置信区间为 1.15-1.81；P =.002）。在中位数为 4.3 年（四分位间距 3.4-5.4 年）的随访期间，72 例患者（15.2%）死亡。在多变量 Cox 回归分析中，半乳糖凝集素-3 预测全因死亡率（每增加 1-SD 的调整风险比为 1.56；95%置信区间为 1.16-2.09；P =.003）。根据分类和回归树分析，半乳糖凝集素-3 水平最高的患者（>11.70 ng/mL）发生 POAF 的风险增加 3.3 倍，死亡风险增加 4.4 倍，而半乳糖凝集素-3 水平最低的患者（≤5.82 ng/mL）则降低了这两种风险。
促纤维化生物标志物半乳糖凝集素-3 是心脏手术后 POAF 和死亡率的独立预测因子。这一发现强调了潜在的心律失常基质在 POAF 发生中的作用。半乳糖凝集素-3 可能有助于识别心脏手术后发生 POAF 和不良结局的高危患者。
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