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Iglesias-Álvarez D, Fu X, Martínez-Cereijo JM, Agra-Bermejo RM, Veiras-Del Río S, Selas-Cobos S, Rial-Munin MV, Eiras-Mariño M, Martínez-Salgado A, Taboada-Muñiz M, Reija-López L, Souaf S, García-Carro J, Fernández-González ÁL, Adrio-Nazar B, González-Juanatey JR, Eiras S, Rodríguez-Mañero M. Clinical Profiling and Biomarkers for Post-Operative Atrial Fibrillation Prediction in Patients Undergoing Cardiac Surgery. J Clin Med 2023; 12:jcm12103565. [PMID: 37240672 DOI: 10.3390/jcm12103565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023] Open
Abstract
Post-operative atrial fibrillation (POAF) is the most common arrhythmia in the post-operative period after cardiac surgery. We aim to investigate the main clinical, local, and/or peripheral biochemical and molecular predictors for POAF in patients undergoing coronary and/or valve surgery. Between August 2020 and September 2022, consecutive patients undergoing cardiac surgery without previous history of AF were studied. Clinical variables, plasma, and biological tissues (epicardial and subcutaneous fat) were obtained before surgery. Pre-operative markers associated with inflammation, adiposity, atrial stretch, and fibrosis were analyzed on peripheral and local samples with multiplex assay and real-time PCR. Univariate and multivariate logistic regression analyses were performed in order to identify the main predictors for POAF. Patients were followed-up until hospital discharge. Out of 123 consecutive patients without prior AF, 43 (34.9%) developed POAF during hospitalization. The main predictors were cardiopulmonary bypass time (odds ratio (OR) 1.008 (95% confidence interval (CI), 1.002-1.013), p = 0.005), and plasma pre-operative orosomucoid levels (OR 1.008 (1.206-5.761). After studying differences regarding sex, orosomucoid was the best predictor for POAF in women (OR 2.639 (95% CI, 1.455-4.788), p = 0.027) but not in men. The results support the pre-operative inflammation pathway as a factor involved in the risk of POAF, mainly in women.
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Affiliation(s)
- Diego Iglesias-Álvarez
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Xiaoran Fu
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - José Manuel Martínez-Cereijo
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Rosa María Agra-Bermejo
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
| | - Sonia Veiras-Del Río
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Salomé Selas-Cobos
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - María Victoria Rial-Munin
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - María Eiras-Mariño
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Adrián Martínez-Salgado
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Manuel Taboada-Muñiz
- Department of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Laura Reija-López
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Souhayla Souaf
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - Javier García-Carro
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | | | - Belén Adrio-Nazar
- Department of Cardiac Surgery, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Sonia Eiras
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - Moisés Rodríguez-Mañero
- Department of Cardiology, Complexo Hospitalario Universitario de Santiago, 15706 Santiago de Compostela, Spain
- Traslational Cardiology, Health Research Institute of Santiago de Compostela (IDIS), 15706 Santiago de Compostela, Spain
- CIBERCV-Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, 28029 Madrid, Spain
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Cole OM. Atrial Fibrillation after Cardiac Surgery-To Infinity and Beyond! Thromb Haemost 2021; 121:1391-1393. [PMID: 33975377 DOI: 10.1055/a-1506-8744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
No Abstract
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Affiliation(s)
- Oana Maria Cole
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom.,Heart and Chest Hospital, Liverpool, United Kingdom
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Schnaubelt S, Stajic A, Koller L, Hofer F, Kazem N, Hammer A, Andreas M, Laufer G, Steinlechner B, Richter B, Niessner A, Sulzgruber P. The impact of invasive respiratory support on the development of postoperative atrial fibrillation following cardiac surgery. J Clin Anesth 2021; 72:110309. [PMID: 33915411 DOI: 10.1016/j.jclinane.2021.110309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Postoperative atrial fibrillation (POAF) is a frequent complication after cardiac valve- or coronary artery bypass (CABG) surgery and is associated with increased mortality. While it is known that prolonged postoperative invasive ventilation triggers POAF, the impact of ventilatory settings on POAF development has not been studied yet. DESIGN Prospective observational study. SETTING Postoperative Intensive Care Unit. PATIENTS Patients having undergone elective CABG and/or cardiac valve surgery. MEASUREMENTS Screening for the development of POAF. Patients' clinical data and postoperative ventilatory settings (driving pressure, controlled pressure above positive endexpiratory pressure (PEEP), respiration rate, and FiO2) were investigated to elucidate their impact on POAF. MAIN RESULTS Out of 441 enrolled individuals, a total of 192 participants developed POAF (43.5%). We observed that POAF patients received a higher peak driving pressure, and a higher peak respiration rate than non-POAF individuals. Within the multivariate regression model, plateau pressure (adjusted OR 1.199 [1.038-1.661], p = 0.019), driving pressure (adjusted OR 1.244 [1.103-1.713], p = 0.021), and peak respiration rate (adjusted OR 1.206 [1.005-1.601], p = 0.040) proved to be independently associated with the development of POAF. CART analysis revealed a cut-off of ≥17.5 cmH2O of plateau pressure, ≥11.5 cmH2O of driving pressure and ≥ 17 respirations per minute as high-risk for POAF development. CONCLUSIONS The ventilatory settings of plateau pressure, driving pressure, and respiration rate after cardiac surgery influence POAF occurrence probability. Optimized postoperative care such as lung-protective ventilation and increased awareness towards postoperative ventilatory efforts should be considered to prevent POAF development and poor patient outcome.
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Affiliation(s)
| | - Alexander Stajic
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Felix Hofer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Niema Kazem
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Andreas Hammer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Martin Andreas
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Günther Laufer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Austria
| | - Barbara Steinlechner
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Austria
| | - Bernhard Richter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria.
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Austria
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