Granchietti Andrea Grasso, Ciardetti Niccolò, Mazzoni Carlotta, Garofalo Manuel, Mazzotta Ruggero, Micheli Serena, Chiostri Marco, Orlandi Matteo, Biagiotti Lucrezia, Del Pace Stefano, Di Mario Carlo, Caciolli Sabina
Department of Cardiac, Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Division of General Cardiology, Florence, Italy.
Department of Cardiac, Thoracic and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Division of General Cardiology, Florence, Italy.
Int J Cardiol. 2025 Mar 1;422:132981. doi: 10.1016/j.ijcard.2025.132981. Epub 2025 Jan 11.
Postoperative Atrial Fibrillation (POAF) is a common complication following Coronary Artery Bypass Grafting (CABG), associated with increased morbidity and mortality. Aim of the study is to analyze whether the measurement of preoperative Left Atrial (LA) strain can offer advantages over conventional clinical and echocardiographic parameters to identify patients at risk of developing POAF.
We conducted a prospective study involving 100 patients undergoing isolated CABG from April 2023 to April 2024. Key parameters measured included LA strain measurements, Left Atrial Emptying Fraction (LA-EF), Left Ventricular Ejection Fraction, Left Atrial Volume index (LAVi). POAF occurred in 27 patients (27 %) with a mean latency of 3.2 ± 2.1 days. Higher preoperative serum creatinine levels were significantly associated with POAF. LA strain parameters (LA Reservoir Strain, LA Contraction Strain) and LA-EF were all significantly lower in the POAF group. Multivariate logistic regression identified LA Contraction Strain (OR: 0.73, p = 0.04), LA Reservoir Strain (OR: 0.27, p = 0.02) and preoperative serum creatinine (OR: 0.55, p = 0.01) as significant predictors of POAF. ROC curve analysis indicated that LA Reservoir Strain ≤24.5 %, LA Contraction Strain ≤9.5 %, LA-EF ≤ 43.4 % have a good accuracy in detection of POAF. Significant correlations were found between LAVi and LA Reservoir Strain, LAVi and LA-EF, and LA Reservoir Strain and LA-EF.
Preoperative LA analysis are significant predictors of POAF. These findings suggest that echocardiographic strain measurements offer an added value in preoperative risk assessment for POAF in CABG patients.
术后心房颤动（POAF）是冠状动脉旁路移植术（CABG）后常见的并发症，与发病率和死亡率增加相关。本研究的目的是分析术前左心房（LA）应变测量是否比传统临床和超声心动图参数更具优势，以识别有发生POAF风险的患者。
我们进行了一项前瞻性研究，纳入了2023年4月至2024年4月期间接受单纯CABG的100例患者。测量的关键参数包括LA应变测量、左心房排空分数（LA-EF）、左心室射血分数、左心房容积指数（LAVi）。27例患者（27%）发生POAF，平均延迟时间为3.2±2.1天。术前血清肌酐水平较高与POAF显著相关。POAF组的LA应变参数（LA储备应变、LA收缩应变）和LA-EF均显著降低。多因素逻辑回归确定LA收缩应变（OR：0.73，p=0.04）、LA储备应变（OR：0.27，p=0.02）和术前血清肌酐（OR：0.55，p=0.01）是POAF的显著预测因素。ROC曲线分析表明，LA储备应变≤24.5%、LA收缩应变≤9.5%、LA-EF≤43.4%在检测POAF方面具有良好的准确性。LAVi与LA储备应变、LAVi与LA-EF以及LA储备应变与LA-EF之间存在显著相关性。
术前LA分析是POAF的重要预测因素。这些发现表明，超声心动图应变测量在CABG患者POAF的术前风险评估中具有附加价值。
