title: Perioperative heart-type fatty acid binding protein levels in atrial fibrillation after cardiac surgery.
abstract: BACKGROUND
  Postoperative atrial fibrillation (POAF) is common and associated with poor outcomes. Perioperative ischemia can alter arrhythmic substrate.
  
  
  OBJECTIVE
  To demonstrate an association between perioperative measurements of heart-type fatty acid binding protein (HT-FABP), a sensitive marker of ischemic myocardial injury.
  
  
  METHODS
  Blood samples from 63 inpatients undergoing coronary artery bypass surgery, valve surgery, or both were obtained before and up to 4 days after surgery. Continuous telemetry monitoring was used to detect POAF. Fifty-nine patients had at least 3 HT-FABP measurements. The relationship of enzyme-linked immunosorbent assay-measured HT-FABP with POAF was assessed by using joint logistic regression adjusted for age and surgery type.
  
  
  RESULTS
  Thirty-five patients (55%) developed POAF; these were, on average, older (69.3±10 years vs 60±11 years; P = .0019), with a higher prevalence of heart failure (43% vs 17%; P = .034), chronic obstructive lung disease (26% vs 4%; P = .017), preoperative calcium channel blocker use (29% vs 7%; P = .031), and more likely to undergo combined surgery (21% vs 11%, P = .049). The joint age- and coronary artery bypass surgery-adjusted model revealed that postoperative but not preoperative HT-FABP levels predicted POAF (coefficient 1.9±0.87; P = .03). Longer bypass time, prior infarction, and worse renal function were all associated with higher postoperative HT-FABP.
  
  
  CONCLUSIONS
  A greater rise of HT-FABP is associated with atrial fibrillation after cardiac surgery, suggesting that ischemic myocardial damage is a contributing underlying mechanism. Interventions that decrease perioperative ischemic injury may also decrease the occurrence of POAF.
authors.affiliation: Heart Institute, Cedars Sinai Medical Center, Los Angeles, California 90048, USA. florian.rader@cshs.org
authors.forename: Florian
authors.initials: F
authors.lastname: Rader
authors.forename: Akshat C
authors.initials: AC
authors.lastname: Pujara
authors.forename: Gregory
authors.initials: G
authors.lastname: Pattakos
authors.forename: Jeevanantham
authors.initials: J
authors.lastname: Rajeswaran
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.forename: Laurie
authors.initials: L
authors.lastname: Castel
authors.forename: Mina K
authors.initials: MK
authors.lastname: Chung
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
authors.forename: Otto
authors.initials: O
authors.lastname: Costantini
authors.forename: David R
authors.initials: DR
authors.lastname: Van Wagoner
authors.forename: Eugene H
authors.initials: EH
authors.lastname: Blackstone
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers / Q000378:metabolism; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000097:blood* / Q000000981:diagnostic imaging / Q000601:surgery*; D004797:Enzyme-Linked Immunosorbent Assay; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications / Q000097:blood / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins