Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
Department of Cardiac Anesthesia, Narayana Institute of Cardiovascular Sciences Bangalore, Karnataka, India.
J Cardiothorac Vasc Anesth. 2024 Nov;38(11):2582-2591. doi: 10.1053/j.jvca.2024.07.047. Epub 2024 Aug 14.
Postoperative atrial fibrillation (POAF) is associated with increased morbidity, mortality, and length of hospital stay. The objective of this study was to assess the utility of left atrial strain (LAS) to predict POAF in patients undergoing off-pump coronary artery bypass grafting (OPCABG).
Retrospective observational study.
Tertiary care hospital.
103 patients undergoing OPCABG.
None.
In addition to comprehensive transthoracic echocardiography, LAS was measured for reservoir (R), conduction (CD), and contraction (CT) components. POAF was defined as new electrocardiographic evidence of AF requiring treatment. Logistic regression was done to assess factors associated with POAF. The diagnostic accuracy of variables in predicting POAF was assessed by receiver operating characteristic analysis. POAF was documented in 24 (23.3%) patients. There was no difference in ejection fraction, average global longitudinal strain, or proportion of left ventricular diastolic dysfunction grades between patients with POAF and patients without POAF. All three components of LAS: LAS R (19.2 ± 4.7 v 23.5 ± 4.8, p < 0.001), LAS CD (8.9 ± 3.7 v 12.3 ± 4.8, p = 0.1), and LAS CT (10.3 ± 3.9 v 12.1 ± 4.1, p = 0.04), were significantly lower among patients with POAF compared with patients without POAF, respectively. According to univariate analysis, all components of LAS were statistically significant predictors of POAF. In multivariate analysis, only age (odds ratio = 1.08, p = 0.025) and LAS R (odds ratio = 0.84, p = 0.004) were independently associated with POAF. LAS R was a better predictor of POAF, with an area under the curve (AUC) of 0.758, than LAS CD (AUC = 0.67) and LAS CT (AUC = 0.62). LAS R had an optimal cutoff of 23% with sensitivity of 95.8% (confidence interval: 78.9-99.9%) and specificity of 49.4% (37.9-60.9%) to predict POAF.
LAS R is a significant predictor of POAF, and its use can be recommended for screening of OPCABG patients at high risk of POAF.
术后心房颤动（POAF）与发病率、死亡率和住院时间延长有关。本研究的目的是评估左房应变（LAS）预测非体外循环冠状动脉旁路移植术（OPCABG）患者 POAF 的效用。
回顾性观察性研究。
三级保健医院。
103 例行 OPCABG 的患者。
无。
除了全面的经胸超声心动图外，还测量了 LAS 的储备（R）、传导（CD）和收缩（CT）成分。POAF 定义为需要治疗的新心电图证据的 AF。进行逻辑回归以评估与 POAF 相关的因素。通过接收者操作特征分析评估变量预测 POAF 的准确性。POAF 记录在 24 名（23.3%）患者中。POAF 患者与无 POAF 患者的射血分数、平均整体纵向应变或左心室舒张功能障碍分级比例无差异。LAS 的所有三个成分：LAS R（19.2 ± 4.7 v 23.5 ± 4.8，p < 0.001）、LAS CD（8.9 ± 3.7 v 12.3 ± 4.8，p = 0.1）和 LAS CT（10.3 ± 3.9 v 12.1 ± 4.1，p = 0.04），在 POAF 患者中均显著低于无 POAF 患者。根据单变量分析，LAS 的所有成分均为 POAF 的统计学显著预测因子。在多变量分析中，只有年龄（比值比=1.08，p=0.025）和 LAS R（比值比=0.84，p=0.004）与 POAF 独立相关。LAS R 是 POAF 的更好预测因子，曲线下面积（AUC）为 0.758，优于 LAS CD（AUC=0.67）和 LAS CT（AUC=0.62）。LAS R 的最佳截断值为 23%，其敏感性为 95.8%（置信区间：78.9-99.9%），特异性为 49.4%（37.9-60.9%），可预测 POAF。
LAS R 是 POAF 的显著预测因子，建议将其用于筛查 OPCABG 患者 POAF 高危人群。
