Usefulness of right ventricular dysfunction to predict new-onset atrial fibrillation following coronary artery bypass grafting.
Postoperative atrial fibrillation (AF) is a serious yet common complication after coronary artery bypass grafting (CABG) surgery. Risk factors for postoperative AF have been identified, including echocardiographic parameters, and these are relied on to implement preventative strategies that reduce the incidence of AF. There has yet to be a study examining the impact of echocardiographic right-sided cardiac parameters on the prediction of postoperative AF. Thus, a panel of right-sided cardiac parameters was measured in a cohort of patients undergoing isolated CABG surgery, excluding those who did not have echocardiographic assessment within 30 days before surgery and those with any history of AF. The primary outcome was postoperative AF defined as any episode of AF requiring treatment during the index hospitalization. Postoperative AF occurred in 197 of 768 patients (25.6%); these were older and more likely to have hypertension and chronic kidney disease. After adjustment for clinical and echocardiographic variables, left atrial volume index ≥34 ml/m(2) (odds ratio [OR] 1.98, 95% confidence interval [CI] 1.36 to 2.87), abnormal right ventricular myocardial performance index (OR 1.50, 95% CI 1.01 to 2.24), and advancing age (OR 1.05, 95% CI 1.03 to 1.07) were found to be independent predictors of postoperative AF. In conclusion, right ventricular myocardial performance index is a novel predictor of postoperative AF in patients undergoing isolated CABG surgery and appears to be additive to established risk factors such as age and left atrial volume.
Division of Cardiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
Avi
A
Shimony
Division of Cardiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada; Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
Jonathan
J
Afilalo
Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
Aidan W
AW
Flynn
Division of Cardiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
David
D
Langleben
Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
Arvin K
AK
Agnihotri
Division of Cardiac Surgery, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada.
Jean-Francois
JF
Morin
Division of Cardiac Surgery, Massachusetts General Hospital, Harvard University, Boston, Massachusetts; Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
David M
DM
Shahian
Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard University, Boston, Massachusetts.
Michael H
MH
Picard
Division of Cardiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada. Electronic address: lrudski@jgh.mcgill.ca.
Lawrence G
LG
Rudski
D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011183:Postoperative Complications; D011237:Predictive Value of Tests; D011379:Prognosis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D018497:Ventricular Dysfunction, Right / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology