Fudulu Daniel Paul, Dimagli Arnaldo, Moscarelli Marco, Kota Rahul, Dong Tim, Gemelli Marco, Sandhu Manraj, Suleiman Saadeh, Angelini Gianni D
Bristol Heart Institute, University of Bristol, Upper Maudlin St., Bristol BS2 8HW, UK.
GVM Care & Research, Department of Cardiovascular Surgery, Anthea Hospital, 70124 Bari, Italy.
J Clin Med. 2025 Jul 7;14(13):4777. doi: 10.3390/jcm14134777.
Postoperative atrial fibrillation (POAF) is a common complication after heart surgery, adversely impacting clinical outcomes and healthcare costs. Little is known about the dynamics of nucleotide metabolism associated with the development of POAF at a ventricular level. We conducted a post hoc trial analysis to investigate the changes in ventricular adenine nucleotides and the clinical predictors associated with the development of AF. Using data from a randomised trial, we analysed ATP/ADP, ATP/AMP, and energy charges in left and right ventricular biopsies of patients who developed AF compared to non-AF patients. A logistic regression model was used to understand the predictors associated with the development of atrial fibrillation in this cohort. We analysed adenine nucleotide levels available in 88 patients who underwent coronary artery bypass grafting (CABG) ( = 65) and aortic valve replacement (AVR) ( = 23), out of which 27 (31%) developed a new onset of AF. Seventeen (43.4%) patients in the CABG group and ten (26.15%) in the AVR group developed AF. The patients who developed postoperative AF had longer cross-clamp times for CABG ( = 0.013) and AVR ( = 0.002). The most significant predictors for AF development were age ( = 0.003) and cross-clamp time ( = 0.012). In patients undergoing CABG who developed AF, we found a significant drop in post-reperfusion ATP/ADP and ATP/AMP ratios compared to pre-reperfusion. This was not significant for the patients who underwent AVR. Furthermore, the patients who underwent CABG and developed AF had higher pre- and post-reperfusion ATP/ADP ratios and energy charges than non-AF patients, suggesting a higher reserve of cardiac nucleotides. The development of postoperative atrial fibrillation is associated with intraoperative changes in the ventricular adenine nucleotide metabolism of patients undergoing CABG. In the clinical analysis, age and cross-clamp time were significant predictors of AF development.
术后心房颤动（POAF）是心脏手术后常见的并发症，对临床结局和医疗成本产生不利影响。关于心室水平上与POAF发生相关的核苷酸代谢动态，人们了解甚少。我们进行了一项事后试验分析，以研究心室腺嘌呤核苷酸的变化以及与房颤发生相关的临床预测因素。利用一项随机试验的数据，我们分析了发生房颤的患者与未发生房颤的患者左、右心室活检组织中的ATP/ADP、ATP/AMP和能荷。使用逻辑回归模型来了解该队列中与房颤发生相关的预测因素。我们分析了88例行冠状动脉旁路移植术（CABG）（n = 65）和主动脉瓣置换术（AVR）（n = 23）患者的腺嘌呤核苷酸水平，其中27例（31%）出现新发房颤。CABG组17例（43.4%）患者和AVR组10例（26.15%）患者发生房颤。发生术后房颤的患者CABG（P = 0.013）和AVR（P = 0.002）的交叉钳夹时间更长。房颤发生的最显著预测因素是年龄（P = 0.003）和交叉钳夹时间（P = 0.012）。在发生房颤的CABG患者中，我们发现再灌注后ATP/ADP和ATP/AMP比值与再灌注前相比显著下降。这在接受AVR的患者中不显著。此外，接受CABG并发生房颤的患者再灌注前后的ATP/ADP比值和能荷高于未发生房颤的患者，提示心脏核苷酸储备更高。术后心房颤动的发生与CABG患者心室腺嘌呤核苷酸代谢的术中变化有关。在临床分析中，年龄和交叉钳夹时间是房颤发生的显著预测因素。
