title: Computed tomography angiography for prediction of atrial fibrillation after coronary artery bypass grafting: proof of concept.
abstract: BACKGROUND
  Postoperative atrial fibrillation (AF) is a serious complication of coronary artery bypass grafting (CABG). There are scant data on the application of coronary computed tomography angiography (CCTA) for prediction of postoperative AF.
  
  
  METHODS
  A total of 102 patients (77 male, mean age: 64±10 years) with pre-procedural CCTA undergoing isolated CABG were enrolled. Clinical risk factors were collected. Qualitative and quantitative CCTA analysis of the atria, pulmonary veins (PV), and epicardial adipose tissue (EAT) along the left atrium (LA) was performed to determine the predictors for postoperative AF. The primary endpoint was defined as any in-hospital AF requiring treatment.
  
  
  RESULTS
  Postoperative AF occurred in 24% of patients. Patients with AF had higher body mass index (29.7±4.8kg/m(2) vs 27.3±3.9kg/m(2), p=0.013), larger right atrial area (25.4±5.3cm(2) vs 22.3±6.4cm(2), p=0.035), LA systolic volume (114.7±32.8ml vs 96.8±30.4ml, p=0.015), LA EAT volume (5.6±3ml vs 4±2.5ml, p=0.009), and right superior PV ostium area (3.8±1.3cm(2) vs 3±1cm(2), p=0.021) compared to non-AF patients. By multivariable analysis, only LA EAT volume [odds ratio (OR): 1.21, 95% confidence interval (CI): 1.01-1.44, p=0.036] and right superior PV ostium area (OR: 1.63, 95% CI: 1.06-2.50, p=0.026) were independent predictors of AF. The optimal cut-offs for LA EAT volume and right superior PV ostium were >3.4ml and >4.1cm(2), respectively (max. sensitivity: 83%, max. specificity: 86%).
  
  
  CONCLUSIONS
  Increased LA EAT and right superior PV ostial size are independently associated with AF after CABG. CCTA might be used as a noninvasive prediction tool for AF in patients undergoing CABG.
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland. Electronic address: opolski.mp@gmail.com.
authors.forename: Maksymilian P
authors.initials: MP
authors.lastname: Opolski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam D
authors.initials: AD
authors.lastname: Staruch
authors.affiliation: Department of Cardiosurgery and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kusmierczyk
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
authors.affiliation: Medical University of Warsaw, Warsaw, Poland.
authors.forename: Sonia
authors.initials: S
authors.lastname: Kwiecinska
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Mikolaj
authors.initials: M
authors.lastname: Kosek
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Jastrzebski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Pregowski
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kruk
authors.affiliation: Department of Cardiosurgery and Transplantology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Rozanski
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Demkow
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyllo
authors.affiliation: Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland.
authors.forename: Cezary
authors.initials: C
authors.lastname: Kepka
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology* / Q000503:physiopathology; D015992:Body Mass Index; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010496:Pericardium / Q000000981:diagnostic imaging / Q000503:physiopathology; D011184:Postoperative Period; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
keywords: Atrial fibrillation; Computed tomography angiography; Coronary bypass grafting