Echocardiographic prediction of postoperative atrial fibrillation after aortic valve replacement for aortic stenosis: a two-dimensional speckle tracking left ventricular longitudinal strain multicentre pilot study.
BACKGROUND
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, with increased risk of embolic events, haemodynamic instability, haemorrhagic complications and prolonged hospital stay.


OBJECTIVE
We sought to assess the value of preoperative left ventricular global longitudinal strain (GLS) for the prediction of POAF in a series of patients with severe symptomatic aortic stenosis who underwent aortic valve replacement (AVR).


METHODS
Fifty-eight consecutive patients (52% men) aged 73±9 years, with severe symptomatic aortic stenosis (aortic valve area<1cm(2) or<0.5cm(2)/m(2)), in sinus rhythm, who underwent AVR were prospectively included in three centres between 2009 and 2010. Complete preoperative echocardiography was performed in all patients, including global and segmental longitudinal strain using two-dimensional speckle tracking.


RESULTS
The POAF incidence was 28/58 (48%). On univariate analysis, aortic valve area (P=0.04), preoperative E/e' ratio (P=0.04) and GLS (P=0.005) were associated with the occurrence of POAF. Chronic obstructive pulmonary disease (P=0.05), preoperative statin treatment (P=0.09), age≥80 years (P=0.09), left ventricular ejection fraction (P=0.09) and systolic pulmonary artery pressure (P=0.06) tended to increase the risk of POAF. The best GLS cut-off value for the prediction of POAF was -15% (82% sensitivity, 53% specificity, area under the curve 0.72). On multivariable analysis, GLS>-15% was the only independent predictor of POAF (odds ratio 7.74, 95% confidence interval [1.15-52.03]; P=0.035).


CONCLUSIONS
Incidence of POAF is high after AVR for severe aortic stenosis. Our results suggest an additive value of the study of left ventricular myocardial deformation to classical clinical and echocardiographic variables for the prediction of POAF in this setting.
Department of Cardiology, Inserm, ERI-12, University Hospital, avenue Laennec, 80054 Amiens cedex 1, France.
Franck
F
Levy
Nicolas
N
Debry
Anne Laure
AL
Labescat
Patrick
P
Meimoun
Dorothée
D
Malaquin
Sylvestre
S
Marechaux
Dan
D
Rusinaru
Antoine
A
Jeu
Pierre-Vladimir
PV
Ennezat
Anne Laure
AL
Castel
Christophe
C
Tribouilloy
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D019540:Area Under Curve; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005260:Female; D005602:France; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left