title: Preoperative tissue Doppler imaging-derived atrial conduction time can predict postoperative atrial fibrillation in patients undergoing aortic valve replacement for aortic valve stenosis.
abstract: BACKGROUND
  Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery and may result in stroke or heart failure and poor prognosis. This study aimed to evaluate a novel index of total atrial conduction time derived from the P-wave onset (lead II) to the peak A' wave on tissue Doppler imaging (PA-TDI duration). The PA-TDI duration was compared with previously reported predictors of POAF, and the optimal cutoff value of PA-DTI was calculated in patients undergoing aortic valve replacement (AVR) for AV stenosis (AS). METHODS AND RESULTS: We enrolled 63 patients undergoing isolated AVR. They underwent transthoracic echocardiography with TDI preoperatively and were monitored postoperatively with continuous electrocardiographic telemetry for 7 days. The hospital stay was significantly longer in the 41 patients with POAF than in the 22 without POAF (33.8±19.7 vs. 24.1±8.1 days, P=0.03). Multivariate analysis revealed that PA-TDI duration (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.02-1.13; P=0.0072) and age (OR, 1.14; CI, 1.03-1.28; P=0.016) were significant independent predictors of POAF. Receiver-operating characteristic curve analysis showed the optimal cutoff values of PA-TDI duration and age were 147.3 ms and 74 years, respectively.
  
  
  CONCLUSIONS
  The PA-TDI duration was an independent predictor of POAF after AVR for AS. Patients with PA-TDI duration >147 ms should be considered high risk and treated appropriately to improve outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Hiroshima University Hospital.
authors.forename: Shinya
authors.initials: S
authors.lastname: Takahashi
authors.forename: Mai
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Keisuke
authors.initials: K
authors.lastname: Watadani
authors.forename: Takahiro
authors.initials: T
authors.lastname: Taguchi
authors.forename: Keijiro
authors.initials: K
authors.lastname: Katayama
authors.forename: Taiichi
authors.initials: T
authors.lastname: Takasaki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kurosaki
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Imai
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D015150:Echocardiography, Doppler; D006329:Heart Conduction System / Q000000981:diagnostic imaging / Q000503:physiopathology; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies