title: Early Transthoracic Echocardiography after Cardiac Surgery Predicts Postoperative Atrial Fibrillation.
abstract: OBJECTIVE
  Postoperative atrial fibrillation (POAF) is frequent after cardiac surgery. We aimed to establish a predictive model of POAF based on postoperative transthoracic echocardiography (TTE) findings.
  
  
  METHODS
  This study included 147 patients (aged 67 ± 11 years; 109 men) undergoing coronary artery bypass grafting and/or aortic valve replacement. TTE and Doppler tissue imaging were performed on intensive care unit arrival after surgery. All patients were continuously monitored during hospitalization. The end point was the appearance of POAF.
  
  
  RESULTS
  POAF appeared in 37 patients (25.2%). These patients were older (69 ± 16 vs. 65 ± 12 years; P < 0.001) and had increased long axis of the left atrium (LA) dimension (5.4 ± 1 vs. 4.8 ± 0.9 cm, P = 0.02), lower early diastolic velocity of the mitral annulus (e') (6.9 ± 2.1 vs. 8 ± 1.8 cm/sec; P < 0.01), and higher early diastolic pulsed Doppler mitral ratio (E)/e' (E/e') (17.4 ± 6.8 vs. 13.8 ± 6; P = 0.01). Left ventricle diastolic dysfunction grade (DFG) of 2 or 3 relative to grade 0 was significant: odds ratio (OR) 22.5, 95% confidence interval (CI) 4.52-57.2; P < 0.001, and OR: 23.6, 95% CI: 3.57-60.1; P = 0.001), respectively. On multivariate analysis, the independent predictors of POAF were age (OR: 1.10, 95% CI: 1.01-1.18; P < 0.05), long-axis LA dimension (OR: 6.24, 95% CI: 1.97-8.23; P = 0.0017), DFG-2 (OR: 4.1, 95% CI: 1.57-15.81; P < 0.001), and DFG-3 (OR: 8.3, 95% CI: 4.11-25.37; P < 0.001).
  
  
  CONCLUSIONS
  Apart from age, the simple determination by postoperative TTE of long-axis LA dimension and DFG after cardiac surgery proved to be powerful independent predictors of POAF and may be useful for risk stratification of these patients.
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain. jlacalzada@gmail.com.
authors.forename: Juan
authors.initials: J
authors.lastname: Lacalzada
authors.affiliation: Department of Critical Care, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Jiménez
authors.affiliation: Department of Critical Care, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Iribarren
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: de la Rosa
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Martín-Cabeza
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: María Manuela
authors.initials: MM
authors.lastname: Izquierdo
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Marí-López
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Martín Jesús
authors.initials: MJ
authors.lastname: García-González
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Jorge-Pérez
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Barragán
authors.affiliation: Department of Cardiology, University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Laynez
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000401:mortality*; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D015984:Causality; D015897:Comorbidity; D042241:Early Diagnosis; D004452:Echocardiography / Q000379:methods / Q000706:statistics & numerical data; D054459:Elasticity Imaging Techniques / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality*; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: aortic valve replacement; cardiac surgery; coronary artery bypass graft surgery; echocardiography; postoperative atrial fibrillation