Scheggi Valentina, Salvicchi Alberto, Menale Silvia, Giovacchini Jacopo, Fumagalli Stefano, Santamaria Emanuele, Spanalatte Giulia, Marcucci Rossella, Voltolini Luca, Marchionni Niccolò
Division of Cardiovascular and Perioperative Medicine, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.
Division of Thoracic Surgery, Cardiothoracovascular Department, Azienda Ospedaliero-Universitaria Careggi and University of Florence, Florence, Italy.
Intern Emerg Med. 2025 Apr 8. doi: 10.1007/s11739-025-03930-6.
Postoperative atrial fibrillation (PoAF) complicates 10-15% of pulmonary lobectomy and 20-30% of pneumonectomy, contributing to increased morbidity, extended hospital stays, and healthcare costs. Identifying predictors of PoAF may aid in risk stratification and preventive care. We prospectively studied 100 consecutive patients who underwent lung surgery for a malignant tumour, including video-assisted thoracic surgery (VATS) and open thoracotomy. Patients with prior atrial fibrillation, cardiac surgery, or thyroid abnormalities were excluded. All patients received pre-operative echocardiography, including speckle-tracking for left atrial (LA) and ventricular function. PoAF incidence was monitored through continuous electrocardiographic follow-up. Univariable and multivariable analyses identified clinical and echocardiographic predictors of PoAF. At univariable analysis, PoAF patients (8%) were more likely to have hypertension (100% vs. 58%, p = 0.018), higher fibrinogen (432 ± 118 mg/dl vs. 346 ± 87 mg/dl, p = 0.03), and lower magnesium levels (1.8 ± 0.2 mEq/l vs. 2.1 ± 0.2 mEq/l, p = 0.003). Echocardiographic differences included larger LA diameter (42 ± 5 mm vs. 35 ± 5 mm, p = 0.002), area (23.8 ± 3.3 cm vs. 17.7 ± 4.5 cm, p < 0.001), and volume (36.9 ± 7.2 ml vs. 28.6 ± 9.4 ml, p = 0.003). Multivariable analysis identified fibrinogen (HR 1.01, p = 0.036), interventricular septal thickness (HR 3.05, p = 0.029), LA area (HR 1.33, p = 0.016) and LA peak contraction strain (PACS, HR 2.3, p = 0.023) as independent PoAF predictors. Hypertension, inflammation, electrolyte imbalance, and LA remodelling were associated with PoAF. Pre-operative identification of these factors may help target high-risk patients for preventive interventions.
术后房颤（PoAF）在10% - 15%的肺叶切除术中以及20% - 30%的肺切除术中出现并发症，导致发病率增加、住院时间延长和医疗费用增加。识别PoAF的预测因素可能有助于进行风险分层和预防性护理。我们前瞻性地研究了100例连续接受肺癌手术的患者，包括电视辅助胸腔镜手术（VATS）和开胸手术。排除有既往房颤、心脏手术或甲状腺异常的患者。所有患者均接受术前超声心动图检查，包括对左心房（LA）和心室功能的斑点追踪。通过连续心电图随访监测PoAF的发生率。单变量和多变量分析确定了PoAF的临床和超声心动图预测因素。在单变量分析中，PoAF患者（8%）更有可能患有高血压（100%对58%，p = 0.018）、纤维蛋白原水平更高（432±118mg/dl对346±87mg/dl，p = 0.03）以及镁水平更低（1.8±0.2mEq/l对2.1±0.2mEq/l，p = 0.003）。超声心动图差异包括更大的LA直径（42±5mm对35±5mm，p = 0.002）、面积（23.8±3.3cm对17.7±4.5cm，p < 0.001）和容积（36.9±7.2ml对28.6±9.4ml，p = 0.003）。多变量分析确定纤维蛋白原（HR 1.01，p = 0.036）、室间隔厚度（HR 3.05，p = 0.029）、LA面积（HR 1.33，p = 0.016）和LA峰值收缩应变（PACS，HR 2.3，p = 0.023）为独立的PoAF预测因素。高血压、炎症、电解质失衡和LA重塑与PoAF相关。术前识别这些因素可能有助于针对高危患者进行预防性干预。
