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Glaser K, Marino L, Stubnya JD, Bilotta F. Machine learning in the prediction and detection of new-onset atrial fibrillation in ICU: a systematic review. J Anesth 2024; 38:301-308. [PMID: 38594589 PMCID: PMC11096200 DOI: 10.1007/s00540-024-03316-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/04/2024] [Indexed: 04/11/2024]
Abstract
Atrial fibrillation (AF) stands as the predominant arrhythmia observed in ICU patients. Nevertheless, the absence of a swift and precise method for prediction and detection poses a challenge. This study aims to provide a comprehensive literature review on the application of machine learning (ML) algorithms for predicting and detecting new-onset atrial fibrillation (NOAF) in ICU-treated patients. Following the PRISMA recommendations, this systematic review outlines ML models employed in the prediction and detection of NOAF in ICU patients and compares the ML-based approach with clinical-based methods. Inclusion criteria comprised randomized controlled trials (RCTs), observational studies, cohort studies, and case-control studies. A total of five articles published between November 2020 and April 2023 were identified and reviewed to extract the algorithms and performance metrics. Reviewed studies sourced 108,724 ICU admission records form databases, e.g., MIMIC. Eight prediction and detection methods were examined. Notably, CatBoost exhibited superior performance in NOAF prediction, while the support vector machine excelled in NOAF detection. Machine learning algorithms emerge as promising tools for predicting and detecting NOAF in ICU patients. The incorporation of these algorithms in clinical practice has the potential to enhance decision-making and the overall management of NOAF in ICU settings.
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Affiliation(s)
- Krzysztof Glaser
- Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I,, Sapienza University of Rome, 00185, Rome, Italy.
| | - Luca Marino
- Department of Mechanical and Aerospace Engineering, Policlinico Umberto I, Sapienza University of Rome, 00185, Rome, Italy
| | | | - Federico Bilotta
- Department of Anaesthesiology, Critical Care and Pain Medicine, Policlinico Umberto I,, Sapienza University of Rome, 00185, Rome, Italy
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Halonen J, Kärkkäinen J, Jäntti H, Martikainen T, Valtola A, Ellam S, Väliaho E, Santala E, Räsänen J, Juutilainen A, Mahlamäki V, Vasankari S, Vasankari T, Hartikainen J. Prevention of Atrial Fibrillation After Cardiac Surgery: A Review of Literature and Comparison of Different Treatment Modalities. Cardiol Rev 2024; 32:248-256. [PMID: 36729126 DOI: 10.1097/crd.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Atrial fibrillation is the most common arrhythmia to occur after cardiac surgery, with an incidence of 10% to 50%. It is associated with postoperative complications including increased risk of stroke, prolonged hospital stays and increased costs. Despite new insights into the mechanisms of atrial fibrillation, no specific etiologic factor has been identified as the sole perpetrator of the arrhythmia. Current evidence suggests that the pathophysiology of atrial fibrillation in general, as well as after cardiac surgery, is multifactorial. Studies have also shown that new-onset postoperative atrial fibrillation following cardiac surgery is associated with a higher risk of short-term and long-term mortality. Furthermore, it has been demonstrated that prophylactic medical therapy decreases the incidence of postoperative atrial fibrillation after cardiac surgery. Of note, the incidence of postoperative atrial fibrillation has not changed during the last decades despite the numerous preventive strategies and operative techniques proposed, although the perioperative and postoperative care of cardiac patients as such has improved.
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Affiliation(s)
- Jari Halonen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kärkkäinen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Tero Martikainen
- Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Antti Valtola
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Sten Ellam
- Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Eemu Väliaho
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Elmeri Santala
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jenni Räsänen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Auni Juutilainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Visa Mahlamäki
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sini Vasankari
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
- The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Hartikainen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
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Emiola A, Kluin J, El Mathari S, de Groot JR, van Boven WJ. Interventions to prevent postoperative atrial fibrillation in Dutch cardiothoracic centres: a survey study. Neth Heart J 2024; 32:173-181. [PMID: 38358408 PMCID: PMC10951169 DOI: 10.1007/s12471-023-01849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Postoperative atrial fibrillation (POAF) is a common phenomenon following cardiac surgery. In this study, we assessed current preventive strategies used by Dutch cardiothoracic centres, identified common views on this matter and related these to international guidelines. METHODS We developed an online questionnaire and sent it to all cardiothoracic surgery centres in the Netherlands. The questionnaire concerned the management of POAF and the use of pharmaceutical therapies (beta-blockers and calcium antagonists) and non-pharmaceutical methods (posterior left pericardiotomy, pericardial flushing and epicardial botulinum toxin type A injections). Usage of electrical cardioversions, anticoagulants and left atrial appendage closure were also enquired. RESULTS Of the 15 centres, 14 (93%) responded to the survey and 13 reported a POAF incidence, ranging from 20 to 30%. Of these 14 centres, 6 prescribed preoperative AF prophylaxis to their patients, of which non-sotalol beta-blockers were prescribed most commonly (57%). Postoperative medication was administered by all centres and included non-sotalol beta-blockers (38%), sotalol (24%), digoxin (14%), calcium antagonists (13%) and amiodarone (10%). Only 2 centres used posterior left pericardiotomy or pericardial flushing as surgical manoeuvres to prevent POAF. Moreover, respondents expressed the need for guidance on anticoagulant use. CONCLUSION Despite the use of various preventive strategies, the reported incidence of POAF was similar in Dutch cardiothoracic centres. This study highlights limited use of prophylactic amiodarone and colchicine, despite recommendations by numerous guidelines, and restricted implementation of surgical strategies to prevent POAF.
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Affiliation(s)
- Angelique Emiola
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sulayman El Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Experimental and Clinical Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Wim-Jan van Boven
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
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Albabtain MA, Almathami EA, Alghosoon H, Alsubaie FF, Abdelaal IM, Ismail H, Adam AI, Arafat AA. Scores predicting atrial fibrillation after mitral valve surgery: Do we need a more specific score? J Arrhythm 2024; 40:342-348. [PMID: 38586847 PMCID: PMC10995589 DOI: 10.1002/joa3.13002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/08/2024] [Accepted: 01/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background Atrial fibrillation after cardiac surgery (POAF) is associated with increased morbidity and mortality. Several scores were used to predict POAF, with variable results. Thus, this study assessed the performance of several scoring systems to predict POAF after mitral valve surgery. Additionally, we identified the risk factors for POAF in those patients. Methods This retrospective cohort included 1381 recruited from 2009 to 2021. The patients underwent mitral valve surgery, and POAF occurred in 233 (16.87%) patients. The performance of CHADS2, CHA2DS2-VASc, POAF, EuroSCORE II, and HATCH scores was evaluated. Results The median age was higher in patients who developed POAF (60 vs. 54 years; p < .001). CHA2-DS2-VASc, POAF, EuroSCORE II, and HATCH scores significantly predicted POAF, with areas under the curve of the receiver operator curve (AUCROC) of 0.56, 0.61, 0.58, and 0.54, respectively. We identified age > 58 years, body mass index > 28 kg/m2, creatinine clearance < 90 mL/min, reoperative surgery, and preoperative inotropic and intra-aortic balloon pump use as predictors of POAF. We constructed a score from these variables (PSCC-AF). A score > 2 significantly predicted POAF (p < .001). The AUCROC of this score was 0.67, which was significantly higher than the AUCROC of the POAF score (p = .009). Conclusion POAF after mitral valve surgery can be predicted based on preoperative patient characteristics. The new PSCC-AF score significantly predicted POAF after mitral valve surgery and can serve as a bedside diagnostic tool for POAF risk screening. Further studies are needed to validate the PSCC-AF-mitral score externally.
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Affiliation(s)
- Monirah A. Albabtain
- Research DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
- Cardiology Clinical Pharmacy DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
| | - Elham A. Almathami
- Cardiology Clinical Pharmacy DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
| | - Haneen Alghosoon
- Research DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
| | - Faisal F. Alsubaie
- Respiratory Therapy DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
| | - Ibrahim M. Abdelaal
- Cardiac Anesthesia DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
- Ahmed Maher Teaching HospitalMinistry of HealthCairoEgypt
| | - Huda Ismail
- Adult Cardiac Surgery DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
| | - Adam I. Adam
- Adult Cardiac Surgery DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
| | - Amr A. Arafat
- Adult Cardiac Surgery DepartmentPrince Sultan Cardiac CenterRiyadhSaudi Arabia
- Cardiothoracic Surgery DepartmentTanta UniversityTantaEgypt
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Suero OR, Ali AK, Barron LR, Segar MW, Moon MR, Chatterjee S. Postoperative atrial fibrillation (POAF) after cardiac surgery: clinical practice review. J Thorac Dis 2024; 16:1503-1520. [PMID: 38505057 PMCID: PMC10944787 DOI: 10.21037/jtd-23-1626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/18/2024] [Indexed: 03/21/2024]
Abstract
Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with elevated morbidity and mortality. Although current prediction models have limited efficacy, several perioperative interventions can reduce patients' risk of POAF. These begin with preoperative medications, including beta-blockers and amiodarone. Moreover, patients should be screened for preexisting atrial fibrillation (AF) so that concomitant surgical ablation and left atrial appendage occlusion can be performed in appropriate candidates. Intraoperative interventions such as posterior pericardiectomy can reduce mediastinal fluid accumulation, which is a trigger for POAF. Furthermore, many preventive strategies for POAF are implemented in the immediate postoperative period. Initiating beta-blockers, amiodarone, or both is reasonable for most patients. Overdrive atrial pacing, colchicine, and steroids have been used by some, although the evidence base is less robust. For patients with POAF, rate-control and rhythm-control strategies have comparable outcomes. Decision-making regarding anticoagulation should recognize that the stroke risk associated with POAF appears to be lower than that for general nonvalvular AF. The evidence that oral anticoagulation reduces stroke risk is less clear for POAF patients than for patients with general nonvalvular AF. Given that POAF tends to be shorter-lived and is associated with greater bleeding risks in the perioperative period, decisions regarding anticoagulation should be individualized. Finally, wearable technology and machine learning algorithms for better predicting and managing POAF appear to be coming soon. These technologies and a comprehensive clinical program could meaningfully reduce the incidence of this common complication.
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Affiliation(s)
- Orlando R. Suero
- Divisions of Cardiovascular Anesthesia & Critical Care Medicine, Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Ahmed K. Ali
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Lauren R. Barron
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, TX, USA
| | - Matthew W. Segar
- Department of Cardiology, The Texas Heart Institute, Houston, TX, USA
| | - Marc R. Moon
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, TX, USA
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, TX, USA
- Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
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Paquin A, Voisine P, Poirier P, Clavel MA, O'Connor S, Roberge J, Piché ME. Sex-Specific Cardiometabolic Determinants of Postoperative Atrial Fibrillation After Cardiac Surgery. Can J Cardiol 2024:S0828-282X(24)00089-8. [PMID: 38342292 DOI: 10.1016/j.cjca.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/19/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Cardiometabolic diseases increase the risk of postoperative atrial fibrillation (POAF), a complication leading to higher long-term risk of major cardiovascular events (MACE). It remains unknown whether the effect of these risk factors differs according to sex. We sought to evaluate the sex-specific predictors of POAF after coronary artery bypass grafting (CABG). METHODS In a prospective registry of patients undergoing isolated CABG, we compared predictors of POAF between sexes with logistic regression models. Because of high prevalence of abdominal obesity in women, > 80% having a waist circumference (WC) ≥ 88 cm, median WC values were used to define abdominal obesity (men ≥ 102 cm, women ≥ 100 cm). RESULTS This analysis included 6177 individuals (17% women). Mean age was 65.6 ± 8.9 years. POAF occurred in 32% of men and 28% of women (P < 0.05). Compared with men, women with POAF had similar WC; higher prevalence of hypertension and diabetes; lower high-density lipoprotein (HDL)-cholesterol; and higher glucose, triglyceride, low- density lipoprotein (LDL)-cholesterol, and C-reactive protein levels (all P < 0.05). After adjustment, age and abdominal obesity were associated with POAF in both sexes (P < 0.05). The interaction of WC with sex suggested a worse impact of WC on POAF risk among women (adjusted odds ratio [OR], 1.97; 95% confidence interval [CI], 1.48-2.62 vs in men 1.33; 95% CI, 1.17-1.50; P for interaction = 0.01). CONCLUSIONS Abdominal obesity is a major predictor of POAF in both sexes, with higher risk in women. These results emphasize the need for enhanced strategies to manage abdominal obesity and its cardiometabolic consequences in the general population and the potential to develop sex-specific preventive interventions to reduce risk of POAF.
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Affiliation(s)
- Amélie Paquin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Pierre Voisine
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Paul Poirier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Pharmacy, Faculty of Pharmacy, Université Laval, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada
| | - Sarah O'Connor
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Jeanne Roberge
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada
| | - Marie-Eve Piché
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec City, Québec, Canada; Department of Medicine, Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
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7
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Chen YC, Liu CC, Hsu HC, Hung KC, Chang YJ, Ho CN, Hsing CH, Yiu CY. Systemic immune-inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis. Front Cardiovasc Med 2024; 11:1290610. [PMID: 38374999 PMCID: PMC10875005 DOI: 10.3389/fcvm.2024.1290610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/24/2024] [Indexed: 02/21/2024] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is a frequent complication that may increase morbidity and mortality risk following cardiac surgery. The systemic immune-inflammation index (SII) is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. Recent studies have reported associations between elevated SII and increased POAF risk; however, significant heterogeneity exists regarding its predictive efficacy. This meta-analysis aimed to assess SII's diagnostic efficacy for predicting POAF risk. Methods To synthesize existing evidence on the ability of perioperative SII for predicting POAF in patients undergoing cardiac surgery, a systematic review and meta-analysis was conducted. In August 2023, a comprehensive literature search was performed to identify relevant studies reporting SII cutoff values with corresponding sensitivity and specificity. The primary aim was to evaluate SII's diagnostic utility for predicting POAF, whereas secondary outcomes included the pooled incidence of POAF and the relationship between the SII and POAF. Results Eight studies published between 2021 and 2023 with 3,245 patients were included. Six studies involved coronary artery bypass grafting (CABG) surgery; one encompassed various cardiac procedures, and another focused solely on mitral valve surgery. The pooled incidence of POAF was 23.6% [95% confidence interval (CI), 18.7%-29.2%]. Elevated SII significantly increased the odds of POAF by 3.24-fold (odds ratio, 3.24; 95% CI, 1.6-6.55; p = 0.001). SII's pooled sensitivity and specificity for predicting POAF were 0.80 (95% CI, 0.68-0.89) and 0.53 (95% CI, 0.23-0.8), respectively. The SII had moderate predictive accuracy based on a hierarchical summary receiver operating characteristic (HSROC) area under the curve of 0.78 (95% CI, 0.74-0.81). Subgroup analyses, whether focusing on CABG alone or CABG with cardiopulmonary bypass (CPB), both indicated an area under the HSROC curve of 0.78 (95% CI, 0.74-0.81). Conclusion Elevated SII is significantly correlated with an increased POAF risk following cardiac surgery, highlighting its utility as a predictive biomarker. Considering its moderate diagnostic accuracy, further research is essential for clarifying SII's clinical effectiveness, either as an independent predictor or combined with other risk factors, for stratifying patients at high POAF risk. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier [CRD42023456128].
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Affiliation(s)
- Yu-Chou Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Liu
- Department of Anesthesiology, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
- Department of Nursing, College of Medicine, I-Shou University, Kaohsiung, Taiwan
- School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Hui-Chen Hsu
- Department of Otolaryngology, Kuang Tien General Hospital, Taichung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ching-Yi Yiu
- Department of Otolaryngology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
- Department of Dental Laboratory Technology, Min-Hwei Junior College of Health Care Management, Liouying, Tainan, Taiwan
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Bowdish ME, Bagiella E, Giustino G, Atluri P, Alexander JH, Thourani VH, Gammie JS, DeRose JJ, Taddei-Peters WC, Jeffries NO, O'Gara PT, Moskowitz AJ, Gillinov M, Gelijns AC, Ailawadi G. Prospective Study of Risk Factors for Postoperative Atrial Fibrillation After Cardiac Surgery. J Surg Res 2024; 294:262-268. [PMID: 37931426 DOI: 10.1016/j.jss.2023.09.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION To examine risk factors for new-onset postoperative atrial fibrillation (POAF) after cardiac surgery. METHODS Patients enrolled in the Cardiothoracic Surgical Trials Network multicenter, randomized trial of rate control versus rhythm control for POAF were included. Predictors of POAF were determined using multivariable logistic regression. RESULTS Among the 2104 patients who were enrolled preoperatively, 695 developed POAF (33.0%). Rates of POAF were 28.1% after isolated coronary artery bypass grafting (CABG), 33.7% after isolated valve repair or replacement, and 47.3% after CABG plus valve repair or replacement. Baseline characteristics associated with an increased risk of POAF identified on multivariable analysis included older age (odds ratio [OR] 1.57; 95% confidence interval [CI] 1.42-1.73, per 10 y), White race or non-Hispanic ethnicity (OR 1.52; CI: 1.11-2.07), history of heart failure (OR 1.55; CI: 1.16-2.08), and history of hypothyroidism (OR 1.42; CI 1.04-1.94). The type of cardiac procedure was associated with an increased risk of POAF with both isolated valve repair or replacement (OR 1.33, CI 1.08-1.64) and combined CABG plus valve repair or replacement (OR 1.64, CI 1.24-2.17) having increased risk of POAF compared to isolated CABG. No preoperative cardiac medication was associated with POAF. CONCLUSIONS In this prospective cohort of patients, older age, a history of hypothyroidism, a history of heart failure, and valve repair or replacement, with or without CABG, and White non-Hispanic race were associated with an increased risk of POAF.
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Affiliation(s)
- Michael E Bowdish
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California
| | - Emilia Bagiella
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health, New York, New York
| | - Gennaro Giustino
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health, New York, New York
| | - Pavan Atluri
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John H Alexander
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia
| | - James S Gammie
- Division of Cardiac Surgery, Johns Hopkins Heart and Vascular Institute, Baltimore, Maryland
| | - Joseph J DeRose
- Department of Cardiothoracic and Vascular Surgery, Montefiore-Einstein Medical Center, New York, New York
| | - Wendy C Taddei-Peters
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland
| | - Neal O Jeffries
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Patrick T O'Gara
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Alan J Moskowitz
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health, New York, New York
| | - Marc Gillinov
- Department of Thoracic & Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Annetine C Gelijns
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai Health, New York, New York.
| | - Gorav Ailawadi
- Cardiac Surgery, University of Michigan Health System, Ann Arbor, Michigan
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9
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Rizza V, Maranta F, Cianfanelli L, Cartella I, Maisano F, Alfieri O, Cianflone D. Subacute postoperative atrial fibrillation after heart surgery: Incidence and predictive factors in cardiac rehabilitation. J Arrhythm 2024; 40:67-75. [PMID: 38333376 PMCID: PMC10848578 DOI: 10.1002/joa3.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 02/10/2024] Open
Abstract
Background Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery (CS). It may occur between the 1st and the 4th postoperative day as acute POAF or between the 5th and the 30th as subacute (sPOAF). sPOAF is associated with higher thromboembolic risk, which consistently increase patients' morbidity. Neutrophil-to-lymphocyte ratio (NLR) is a low-cost inflammatory index proposed as possible POAF predictor. Identification of patients' risk categories might lead to improved postoperative outcomes. Methods The aim was to assess the incidence of sPOAF and to identify possible predictors in patients performing cardiovascular rehabilitation (CR) after CS. A single-center cohort study was performed on 737 post-surgical patients admitted to CR on sinus rhythm. Continuous monitoring with 12-lead ECG telemetry was performed. We evaluated the predictive role of anamnestic, clinical, and laboratory data, including baseline NLR. Results Subacute POAF was documented in 170 cases (23.1%). At the multivariate analysis, age (OR 1.03; p = .001), mitral valve surgery (OR 1.77; p = .012), acute POAF (OR 2.97; p < .001), and NLR at baseline (OR 1.13; p = .042) were found to be independent predictive factors of sPOAF following heart surgery. Conclusions sPOAF is common after CS. Age, mitral valve procedures, acute POAF, and preoperative NLR were proved to increase sPOAF occurrence in CR. NLR is an affordable and reliable parameter which might be used to qualify the risk of arrhythmias at CR admission. Identification of new predictors of postoperative atrial fibrillation may allow to improve patients' prognosis.
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Affiliation(s)
- Vincenzo Rizza
- Vita‐Salute San Raffaele UniversityMilanItaly
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco Maranta
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Lorenzo Cianfanelli
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Iside Cartella
- School of Medicine and SurgeryMilano‐Bicocca UniversityMilanItaly
| | - Francesco Maisano
- Cardiac Surgery UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Ottavio Alfieri
- Cardiac Surgery UnitIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Domenico Cianflone
- Vita‐Salute San Raffaele UniversityMilanItaly
- Cardiac Rehabilitation UnitIRCCS San Raffaele Scientific InstituteMilanItaly
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10
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Pandey A, Okaj I, Ichhpuniani S, Tao B, Kaur H, Spence JD, Young J, Healey JS, Devereaux PJ, Um KJ, Benz AP, Conen D, Whitlock RP, Belley-Cote EP, McIntyre WF. Risk Scores for Prediction of Postoperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-Analysis. Am J Cardiol 2023; 209:232-240. [PMID: 37922611 DOI: 10.1016/j.amjcard.2023.08.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 11/07/2023]
Abstract
Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and is associated with poor clinical outcomes. The objective of this systematic review and meta-analysis was to assess the performance of risk scores to predict POAF in cardiac surgery patients. We searched MEDLINE, Embase, and Cochrane CENTRAL for studies that developed/evaluated a POAF risk prediction model. Pairs of reviewers independently screened studies and extracted data. We pooled area under the receiver operating curves (AUCs), sensitivity and specificity, and adjusted odds ratios from multivariable regression analyses using the generic inverse variance method and random effects models. Forty-three studies (n = 63,847) were included in the quantitative synthesis. Most scores were originally developed for other purposes but evaluated for predicting POAF. Pooled AUC revealed moderate POAF discrimination for the EuroSCORE II (AUC 0.59, 95% confidence interval [CI] 0.54 to 0.65), Society of Thoracic Surgeons (AUC 0.60, 95% CI 0.56 to 0.63), EuroSCORE (AUC 0.63, 95% CI 0.58 to 0.68), CHADS2 (AUC 0.66, 95% CI 0.57 to 0.75), POAF Score (AUC 0.66, 95% CI 0.63 to 0.68), HATCH (AUC 0.67, 95% CI 0.57 to 0.75), CHA2DS2-VASc (AUC 0.68, 95% CI 0.60 to 0.75) and SYNTAX scores (AUC 0.74, 95% CI 0.71 to 0.78). Pooled analyses at specific cutoffs of the CHA2DS2-VASc, CHADS2, HATCH, and POAF scores demonstrated moderate-to-high sensitivity (range 46% to 87%) and low-to-moderate specificity (range 31% to 70%) for POAF prediction. In conclusion, existing clinical risk scores offer at best moderate prediction for POAF after cardiac surgery. Better models are needed to guide POAF risk stratification in cardiac surgery patients.
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Affiliation(s)
- Arjun Pandey
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Iva Okaj
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Brendan Tao
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hargun Kaur
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Jack Young
- Health Sciences Library, McMaster University, Hamilton, Ontario, Canada
| | - Jeff S Healey
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - P J Devereaux
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Kevin J Um
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | | | - David Conen
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Emilie P Belley-Cote
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - William F McIntyre
- Population Health Research Institute, Hamilton, Ontario, Canada; Division of Cardiology, McMaster University, Hamilton, Ontario, Canada.
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11
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Aggarwal R, Siems C, Potel KN, Hingtgen A, Wang Q, Nijjar PS, Huddleston SJ, John R, Kelly RF, Voeller RK. New-onset postoperative atrial fibrillation after mitral valve surgery: Determinants and the effect on survival. JTCVS OPEN 2023; 16:305-320. [PMID: 38204696 PMCID: PMC10775066 DOI: 10.1016/j.xjon.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/29/2023] [Accepted: 08/28/2023] [Indexed: 01/12/2024]
Abstract
Objective Mitral valve surgery (MVS) carries substantial risk of postoperative atrial fibrillation (PAF). Identifying patients who benefit from prophylactic left atrial appendage amputation (LAAA) or maze is ill-defined. To guide such interventions, we determined preoperative predictors of PAF and investigated 3-year survival of patients with PAF. Methods We performed a retrospective analysis of patients undergoing isolated MVS (N = 670) between 2011 and 2021. Patients with preoperative atrial fibrillation, LAAA or pulmonary vein isolation were excluded. Patient characteristics were compared between those without PAF and those who developed transient or prolonged PAF. Predictors of any PAF and prolonged PAF were identified using multivariable regression analysis. Results In total, 504 patients without preoperative atrial fibrillation underwent isolated MVS. Of them, 303 patients (60.2%) developed PAF; 138 (27.3%) developed transient and 165 (32.7%) developed prolonged (beyond 30 days) PAF. Patients with PAF were older (65.7 vs 54.3 years, P < .001), with larger left atria (4.8 vs 4.3 cm, P < .001), greater prevalence of hypertension (60% vs 47.8%, P < .05), and were New York Heart Association class III/IV (36% vs 8.5%, P < .001). Independent predictors of PAF included left atria volume index (odds ratio [OR], 1.02; P < .003), older age (OR, 1.04; P < .001), heart failure (OR, 6.73; P < .001), and sternotomy (OR, 2.19; P < .002). Age, heart failure, and sternotomy were independent predictors of prolonged PAF. Patients with PAF had greater mortality at 3 years compared with those without PAF (5.3% vs 0.5%, P < .005). On multivariable analysis, PAF was associated with increased mortality (hazard ratio, 7.81; P < .046). Conclusions PAF is common after MVS and associated with late mortality. Older age, advanced heart failure, and sternotomy are associated with prolonged PAF. These factors may identify patients who would benefit from prophylactic LAAA or ablation during MVS.
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Affiliation(s)
- Rishav Aggarwal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Chesney Siems
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Koray N. Potel
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | | | - Qi Wang
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minn
| | - Prabhjot S. Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn
| | - Stephen J. Huddleston
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Rosemary F. Kelly
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
| | - Rochus K. Voeller
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn
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12
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Chia AXF, Pang PYK. Predicting postoperative atrial fibrillation after off-pump coronary artery bypass surgery-an ongoing story. J Thorac Dis 2023; 15:5294-5296. [PMID: 37969271 PMCID: PMC10636482 DOI: 10.21037/jtd-23-1343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 09/15/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Alicia X F Chia
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore
| | - Philip Y K Pang
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore, Singapore
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13
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Segar MW, Marzec A, Razavi M, Mullins K, Molina-Razavi JE, Chatterjee S, Shafii AE, Cozart JR, Moon MR, Rasekh A, Saeed M. Incidence, Risk Score Performance, and In-Hospital Outcomes of Postoperative Atrial Fibrillation After Cardiac Surgery. Tex Heart Inst J 2023; 50:e238221. [PMID: 37885133 PMCID: PMC10658140 DOI: 10.14503/thij-23-8221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) frequently complicates cardiac surgery. Predicting POAF can guide interventions to prevent its onset. This study assessed the incidence, risk factors, and related adverse outcomes of POAF after cardiac surgery. METHODS A cohort of 1,606 patients undergoing cardiac surgery at a tertiary referral center was analyzed. Postoperative AF was defined based on the Society of Thoracic Surgeons' criteria: AF/atrial flutter after operating room exit that either lasted longer than 1 hour or required medical or procedural intervention. Risk factors for POAF were evaluated, and the performance of established risk scores (POAF, HATCH, COM-AF, CHA2DS2-VASc, and Society of Thoracic Surgeons risk scores) in predicting POAF was assessed using discrimination (area under the receiver operator characteristics curve) analysis. The association of POAF with secondary outcomes, including length of hospital stay, ventilator time, and discharge to rehabilitation facilities, was evaluated using adjusted linear and logistic regression models. RESULTS The incidence of POAF was 32.2% (n = 517). Patients who developed POAF were older, had traditional cardiovascular risk factors and higher Society of Thoracic Surgeons risk scores, and often underwent valve surgery. The POAF risk score demonstrated the highest area under the receiver operator characteristics curve (0.65), but risk scores generally underperformed. Postoperative AF was associated with extended hospital stays, longer ventilator use, and higher likelihood of discharge to rehabilitation facilities (odds ratio, 2.30; 95% CI, 1.73-3.08). CONCLUSION This study observed a high incidence of POAF following cardiac surgery and its association with increased morbidity and resource utilization. Accurate POAF prediction remains elusive, emphasizing the need for better risk-prediction methods and tailored interventions to diminish the effect of POAF on patient outcomes.
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Affiliation(s)
- Matthew W. Segar
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Alexander Marzec
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mehdi Razavi
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Karen Mullins
- Quality Cardiovascular Service Line, Baylor St Luke's Medical Center, Houston, Texas
| | | | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Alexis E. Shafii
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Jennifer R. Cozart
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Marc R. Moon
- Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas
- Department of Cardiovascular Surgery, The Texas Heart Institute, Houston, Texas
| | - Abdi Rasekh
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
| | - Mohammad Saeed
- Department of Cardiology, The Texas Heart Institute, Houston, Texas
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14
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Khalpey Z, Wilson P, Suri Y, Culbert H, Deckwa J, Khalpey A, Rozell B. Leveling Up: A Review of Machine Learning Models in the Cardiac ICU. Am J Med 2023; 136:979-984. [PMID: 37343909 DOI: 10.1016/j.amjmed.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Machine learning has emerged as a significant tool to augment the medical decision-making process. Studies have steadily accrued detailing algorithms and models designed using machine learning to predict and anticipate pathologic states. The cardiac intensive care unit is an area where anticipation is crucial in the division between life and death. In this paper, we aim to review important studies describing the utility of machine learning algorithms to describe the future of artificial intelligence in the cardiac intensive care unit, especially in regards to the prediction of successful ventilatory weaning, acute respiratory distress syndrome, arrhythmia, and acute kidney injury.
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Affiliation(s)
- Zain Khalpey
- Division of Cardiothoracic Surgery, Heart and Vascular Institute, HonorHealth, Scottsdale, Ariz.
| | | | - Yash Suri
- University of Arizona College of Medicine, Tucson
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15
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Zhang H, Qiao H, Yang B, Lu Y, Bai T, Xue J, Liu Y. Development and validation of a diagnostic model based on left atrial diameter to predict postoperative atrial fibrillation after off-pump coronary artery bypass grafting. J Thorac Dis 2023; 15:3708-3725. [PMID: 37559620 PMCID: PMC10407488 DOI: 10.21037/jtd-22-1706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 06/09/2023] [Indexed: 08/11/2023]
Abstract
Background This cohort study collected the clinical data of patients who underwent off-pump coronary artery bypass grafting (OPCABG) during hospitalization to observe the occurrence of postoperative atrial fibrillation (POAF), construct a POAF prediction model for CABG patients based on the left atrial diameter (LAD), and assist clinicians in making better medical decisions. Methods In this study, all patients who had no prior history of arrhythmia and who had received isolated OPCABG between May 1, 2021, and February 1, 2022, at Beijing Anzhen Hospital Affiliated to Capital Medical University (n=749) were reviewed. Depending on an optimal cutoff obtained from receiver operating characteristic (ROC) curve analysis, patients were separated into two groups: a group with POAF (n=188) and a group without POAF (n=561). The incidence of POAF was then compared. Prediction models were built, and nomograms were plotted was plotted. Model evaluation, including calibration curve and decision curve analysis, was performed. Results In all, 188 out of 749 (25.1%) patients who underwent cardiac surgery experienced POAF. Multifactorial logistic regression analysis showed that age ≥66 years, LAD ≥39 mm, and post-OPCABG atrial fibrillation (AF) were independently associated. The prognostic nomogram model showed good concordance index (C-index) scores. Decision curve analysis suggested the clinical benefit of the prediction models. Conclusions In this study, a prediction model for patients with POAF after OPCABG was assessed, which was shown to make more accurate predictions compared with the original risk prediction system. It may assist doctors to optimize management of patients with POAF.
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Affiliation(s)
- Hao Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Huanyu Qiao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Bo Yang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yifan Lu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Tao Bai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Jinrong Xue
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Yongmin Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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16
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Taghizadeh-Waghefi A, Petrov A, Jatzke P, Wilbring M, Kappert U, Matschke K, Alexiou K, Arzt S. Minimally Invasive Isolated Aortic Valve Replacement in a Potential TAVI Cohort of Patients Aged ≥ 75 Years: A Propensity-Matched Analysis. J Clin Med 2023; 12:4963. [PMID: 37568365 PMCID: PMC10420005 DOI: 10.3390/jcm12154963] [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: 02/26/2023] [Revised: 07/09/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
(1) Background and Objectives: Transcatheter aortic valve implantation is guideline-recommended from the age of 75. However, this European guideline recommendation is based on limited evidence, since no interaction between age and primary outcome has been found in guideline-stated references. This study aimed to compare the short-term outcomes of minimally invasive isolated aortic valve replacement in patients aged ≥ 75 with those of younger patients; (2) Patients and Methods: This retrospective cohort study included 1339 patients who underwent minimally invasive isolated aortic valve replacement at our facility between 2014 and 2022. This cohort was divided into two age-based groups: <75 and ≥75 years. Operative morbidity and mortality were compared between groups. Further analysis was performed using propensity score matching; (3) Results: After matching, 347 pairs of patients were included and analyzed. Despite the higher EuroSCORE II in the ≥75 group (2.2 ± 1.3% vs. 1.80 ± 1.34%, p ≤ 0.001), the 30-day mortality (1.4% vs. 1.2%; p = 0.90) and major adverse cardiac and cerebrovascular events, such as perioperative myocardial infarction (0.0% vs. 1.2%, p = 0.12) and stroke (1.4% vs. 2.6%, p = 0.06), were comparable between both treatment groups; (4) Conclusions: Minimally invasive aortic valve replacement is a safe treatment method for patients aged ≥ 75. Our results indicate that the unilateral cut-off of 75 years is not a limiting factor for performing minimally invasive aortic valve replacement.
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Affiliation(s)
- Ali Taghizadeh-Waghefi
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Asen Petrov
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Philipp Jatzke
- Anesthesiology and Intensive Care Medicine, Dresden University Hospital, Faculty of Medicine, Technical University of Dresden, 01307 Dresden, Germany
| | - Manuel Wilbring
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Utz Kappert
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Klaus Matschke
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Faculty of Medicine, Technical University of Dresden, 01037 Dresden, Germany
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17
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Zhu S, Che H, Fan Y, Jiang S. Prediction of new onset postoperative atrial fibrillation using a simple Nomogram. J Cardiothorac Surg 2023; 18:139. [PMID: 37046315 PMCID: PMC10099883 DOI: 10.1186/s13019-023-02198-1] [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: 08/18/2022] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND New onset postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, with an incidence ranging from 15 to 50%. This study aimed to develop a new nomogram to predict POAF using preoperative and intraoperative risk factors. METHODS We retrospectively analyzed the data of 2108 consecutive adult patients (> 18 years old) who underwent cardiac surgery at our medical institution. The types of surgery included isolated coronary artery bypass grafting, valve surgery, combined valve and coronary artery bypass grafting (CABG), or aortic surgery. Logistic regression or machine learning methods were applied to predict POAF incidence from a subset of 123 parameters. We also developed a simple nomogram based on the strength of the results and compared its predictive ability with that of the CHA2DS2-VASc and POAF scores currently used in clinical practice. RESULTS POAF was observed in 414 hospitalized patients. Logistic regression provided the highest area under the receiver operating characteristic curve (ROC) in the validation cohort. A simple bedside tool comprising three variables (age, left atrial diameter, and surgery type) was established, which had a discriminative ability with a ROC of 0.726 (95% CI 0.693-0.759) and 0.727 (95% CI 0.676-0.778) in derivation and validation subsets respectively. The calibration curve of the new model was relatively well-fit (p = 0.502). CONCLUSIONS Logistic regression performed better than machine learning in predicting POAF. We developed a nomogram that may assist clinicians in identifying individuals who are prone to POAF.
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Affiliation(s)
- Siming Zhu
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Hebin Che
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China
| | - Yunlong Fan
- Medical School of Chinese PLA, Beijing, 100853, China
| | - Shengli Jiang
- Department of Cardiovascular Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Rd, Beijing, 100853, China.
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18
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Chyou JY, Barkoudah E, Dukes JW, Goldstein LB, Joglar JA, Lee AM, Lubitz SA, Marill KA, Sneed KB, Streur MM, Wong GC, Gopinathannair R. Atrial Fibrillation Occurring During Acute Hospitalization: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e676-e698. [PMID: 36912134 DOI: 10.1161/cir.0000000000001133] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Acute atrial fibrillation is defined as atrial fibrillation detected in the setting of acute care or acute illness; atrial fibrillation may be detected or managed for the first time during acute hospitalization for another condition. Atrial fibrillation after cardiothoracic surgery is a distinct type of acute atrial fibrillation. Acute atrial fibrillation is associated with high risk of long-term atrial fibrillation recurrence, warranting clinical attention during acute hospitalization and over long-term follow-up. A framework of substrates and triggers can be useful for evaluating and managing acute atrial fibrillation. Acute management requires a multipronged approach with interdisciplinary care collaboration, tailoring treatments to the patient's underlying substrate and acute condition. Key components of acute management include identification and treatment of triggers, selection and implementation of rate/rhythm control, and management of anticoagulation. Acute rate or rhythm control strategy should be individualized with consideration of the patient's capacity to tolerate rapid rates or atrioventricular dyssynchrony, and the patient's ability to tolerate the risk of the therapeutic strategy. Given the high risks of atrial fibrillation recurrence in patients with acute atrial fibrillation, clinical follow-up and heart rhythm monitoring are warranted. Long-term management is guided by patient substrate, with implications for intensity of heart rhythm monitoring, anticoagulation, and considerations for rhythm management strategies. Overall management of acute atrial fibrillation addresses substrates and triggers. The 3As of acute management are acute triggers, atrial fibrillation rate/rhythm management, and anticoagulation. The 2As and 2Ms of long-term management include monitoring of heart rhythm and modification of lifestyle and risk factors, in addition to considerations for atrial fibrillation rate/rhythm management and anticoagulation. Several gaps in knowledge related to acute atrial fibrillation exist and warrant future research.
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19
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López-Galvez R, Rivera-Caravaca JM, Roldán V, Orenes-Piñero E, Esteve-Pastor MA, López-García C, Saura D, González J, Lip GYH, Marín F. Imaging in atrial fibrillation: A way to assess atrial fibrosis and remodeling to assist decision-making. Am Heart J 2023; 258:1-16. [PMID: 36526006 DOI: 10.1016/j.ahj.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 11/22/2022] [Accepted: 12/10/2022] [Indexed: 05/11/2023]
Abstract
The 2020 ESC atrial fibrillation (AF) guidelines suggest the novel 4S-AF scheme for the characterization of AF. Imaging techniques could be helpful for this objective in everyday clinical practice, and information derived from these techniques reflects basic aspects of the pathophysiology of AF, which may facilitate treatment decision-making, and optimal management of AF patients. The aim of this review is to provide an overview of the mechanisms associated with atrial fibrosis and to describe imaging techniques that may help the management of AF patients in clinical practice. Transthoracic echocardiography is the most common procedure given its versatility, safety, and simplicity. Transesophageal echocardiography provides higher resolution exploration, and speckle tracking echocardiography can provide incremental functional and prognostic information over conventional echocardiographic parameters. In addition, LA deformation imaging, including LA strain and strain rate, are related to the extent of fibrosis. On the other hand, multidetector-row computed tomography and cardiac magnetic resonance provide higher resolution data and more accurate assessment of the dimensions, structure, and spatial relationships of the LA. Imaging is central when deciding on catheter ablation or cardioversion, and helps in selecting those patients who will really benefit from these procedures. Moreover, imaging enhances the understanding of the underlying mechanisms of atrial remodeling and might assists in refining the risk of stroke, which help to select the best medical therapies/interventions. In summary, evaluation of LA enlargement, LA remodeling and fibrosis with imaging techniques adds clinical and prognostic information and should be assessed as a part of routine comprehensive AF evaluation.
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Affiliation(s)
- Raquel López-Galvez
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; School of Nursing, University of Murcia, Murcia, Spain; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
| | - Vanessa Roldán
- Department of Hematology and Clinical Oncology, Hospital General Universitario Morales Meseguer, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain
| | - Esteban Orenes-Piñero
- Department of Biochemistry and Molecular Biology, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Cecilia López-García
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Daniel Saura
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Josefa González
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
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Zhang RJZ, Yu XY, Wang J, Lv J, Zheng Y, Yu MH, Zang YR, Shi JW, Wang JH, Wang L, Liu ZG. A prediction model for new-onset atrial fibrillation following coronary artery bypass graft surgery: A multicenter retrospective study. Heliyon 2023; 9:e14656. [PMID: 37020944 PMCID: PMC10068116 DOI: 10.1016/j.heliyon.2023.e14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 03/28/2023] Open
Abstract
Objective Developing and assessing a risk prediction model of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG), and aims to provide a reference for the prediction and prevention. Design A retrospective case-control study. Setting Three major urban teaching and university hospitals and tertiary referral centers. Participants consecutive patients undergoing CABG. Interventions The study was retrospective and no interventions were administered to patients. Measurements and main results In the study, the overall new-onset POAF prevalence was approximately 28%. A prediction model for POAF with nine significant indicators was developed, and identified new predictors of POAF: left ventricular end diastolic diameter (LVEDD), intraoperative defibrillation, and intraoperative temporary pacing lead implantation. The model had good discrimination in both the derivation and validation cohorts, with the area under the receiver operating characteristic curves (AUCs) of 0.621 (95% CI = 0.602-0.640) and 0.616 (95% CI = 0.579-0.651), respectively, and showed good calibration. Compared with CHA2DS2-VASc, HATCH score, and the prediction model of POAF after CABG developed based on a small sample of clinical data from a single center in China, the model in this study had better discrimination. Conclusion We have developed and validated a new prediction model of POAF after CABG using multicenter data that can be used in the clinic for early identification of high-risk patients of POAF, and to help effectively prevent POAF in postoperative patients.
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Affiliation(s)
- Ren-Jian-Zhi Zhang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Xin-Yi Yu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Jing Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 6913114, China
| | - Jian Lv
- Department of Cardiovascular Surgery, Nanyang Central Hospital, Nanyang, 473005, China
| | - Yan Zheng
- First School of Clinical Medicine, Lanzhou University, Lanzhou, 730013, China
| | - Ming-Huan Yu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Yi-Rui Zang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Jian-Wei Shi
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Jia-Hui Wang
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
| | - Li Wang
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 6913114, China
| | - Zhi-Gang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences & Graduate School of Peking Union Medical College, Tianjin, 300457, China
- Corresponding author.
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21
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Liu Y, Yu M, Wu Y, Wu F, Feng X, Zhao H. Myeloperoxidase in the pericardial fluid improves the performance of prediction rules for postoperative atrial fibrillation. J Thorac Cardiovasc Surg 2023; 165:1064-1077.e8. [PMID: 34275621 DOI: 10.1016/j.jtcvs.2021.06.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/15/2021] [Accepted: 06/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES After surgery, inflammation is a prominent factor influencing postoperative atrial fibrillation. Myeloperoxidase is a major contributor to inflammatory responses after surgical tissue damage. We evaluated whether myeloperoxidase is associated with postoperative atrial fibrillation clinically and in an animal model. METHODS This prospective cohort study included patients undergoing isolated coronary artery bypass grafting. Myeloperoxidase concentrations in blood and pericardial fluid were determined at baseline and 6, 12, and 18 hours after coronary artery bypass grafting. Myeloperoxidase activity in blood, pericardial fluid, and atrium were also evaluated in a canine coronary artery bypass grafting model. Electrophysiologic, histologic, and immunohistochemistry analyses were performed to explore underlying mechanisms. RESULTS Postoperative atrial fibrillation occurred in 45 of 137 patients (32.8%). Patients with postoperative atrial fibrillation had significantly higher serum and pericardial myeloperoxidase levels. Individual clinical and surgical factors had moderate predictive value (area under the curve, 0.760) for postoperative atrial fibrillation. Discrimination improved remarkably when myeloperoxidase was combined with other parameters (area under the curve, 0.901). Pericardial myeloperoxidase at 6 hours postoperatively was the strongest independent predictor of postoperative atrial fibrillation (odds ratio, 19.215). The rate of postoperative atrial fibrillation increased exponentially across pericardial myeloperoxidase grades. Compared with controls, coronary artery bypass grafting-treated dogs showed higher atrial fibrillation vulnerability and maintenance, shorter atrial effective refractory period, attenuated connexin 43 expression, and increased myocardial and pericardial myeloperoxidase activity. Connexin 43 expression and atrial effective refractory period were strongly negatively correlated with myocardial and pericardial myeloperoxidase activity. CONCLUSIONS Myeloperoxidase is linked to postoperative atrial fibrillation, and the ability to predict postoperative atrial fibrillation was remarkably improved by adding pericardial myeloperoxidase. Myeloperoxidase-related atrial structural and electrical remodeling is a physiologic substrate for this arrhythmia.
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Affiliation(s)
- Yisi Liu
- Capital Medical University, Beijing, P. R. China
| | - Meng Yu
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, P.R. China
| | - Ying Wu
- Capital Medical University, Beijing, P. R. China.
| | - Fangqin Wu
- Capital Medical University, Beijing, P. R. China
| | - Xinwei Feng
- Capital Medical University, Beijing, P. R. China
| | - Haibo Zhao
- Beijing Chao-yang Hospital affiliated to Capital Medical University, Beijing, P.R. China
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22
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Lu Y, Chen Q, Zhang H, Huang M, Yao Y, Ming Y, Yan M, Yu Y, Yu L. Machine Learning Models of Postoperative Atrial Fibrillation Prediction After Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:360-366. [PMID: 36535840 DOI: 10.1053/j.jvca.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/06/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to use machine learning algorithms to build an efficient forecasting model of atrial fibrillation after cardiac surgery, and to compare the predictive performance of machine learning to traditional logistic regression. DESIGN A retrospective study. SETTING Second Affiliated Hospital of Zhejiang University School of Medicine. PARTICIPANTS The study comprised 1,400 patients who underwent valve and/or coronary artery bypass grafting surgery with cardiopulmonary bypass from September 1, 2013 to December 31, 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two machine learning approaches (gradient-boosting decision tree and support-vector machine) and logistic regression were used to build predictive models. The performance was compared by the area under the curve (AUC). The clinical practicability was assessed using decision curve analysis. Postoperative atrial fibrillation occurred in 519 patients (37.1%). The AUCs of the support-vector machine, logistic regression, and gradient boosting decision tree were 0.777 (95% CI: 0.772-0.781), 0.767 (95% CI: 0.762-0.772), and 0.765 (95% CI: 0.761-0.770), respectively. As decision curve analysis manifested, these models had achieved appropriate net benefit. CONCLUSION In the authors' study, the support-vector machine model was the best predictor; it may be an effective tool for predicting atrial fibrillation after cardiac surgery.
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Affiliation(s)
- Yufan Lu
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China; Department of Anesthesiology, Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, China
| | - Qingjuan Chen
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Hu Zhang
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Meijiao Huang
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Yu Yao
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Yue Ming
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Yunxian Yu
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Lina Yu
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China.
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Tohyama T, Ide T, Ikeda M, Nagata T, Tagawa K, Hirose M, Funakoshi K, Sakamoto K, Kishimoto J, Todaka K, Nakashima N, Tsutsui H. Deep Learning of ECG for the Prediction of Postoperative Atrial Fibrillation. Circ Arrhythm Electrophysiol 2023; 16:e011579. [PMID: 36716179 DOI: 10.1161/circep.122.011579] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Takeshi Tohyama
- Center for Clinical and Translational Research (T.T., K. Tagawa, M.H., K.F., J.K., K. Todaka), Kyushu University Hospital, Fukuoka, Japan.,Department of Cardiovascular Medicine (T.T., T.I., M.I., T.N., K.S., H.T.), Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine (T.T., T.I., M.I., T.N., K.S., H.T.), Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masataka Ikeda
- Department of Cardiovascular Medicine (T.T., T.I., M.I., T.N., K.S., H.T.), Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Immunoregulatory Cardiovascular Medicine (M.I.), Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuya Nagata
- Department of Cardiovascular Medicine (T.T., T.I., M.I., T.N., K.S., H.T.), Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koshiro Tagawa
- Center for Clinical and Translational Research (T.T., K. Tagawa, M.H., K.F., J.K., K. Todaka), Kyushu University Hospital, Fukuoka, Japan
| | - Masayuki Hirose
- Center for Clinical and Translational Research (T.T., K. Tagawa, M.H., K.F., J.K., K. Todaka), Kyushu University Hospital, Fukuoka, Japan
| | - Kouta Funakoshi
- Center for Clinical and Translational Research (T.T., K. Tagawa, M.H., K.F., J.K., K. Todaka), Kyushu University Hospital, Fukuoka, Japan
| | - Kazuo Sakamoto
- Department of Cardiovascular Medicine (T.T., T.I., M.I., T.N., K.S., H.T.), Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research (T.T., K. Tagawa, M.H., K.F., J.K., K. Todaka), Kyushu University Hospital, Fukuoka, Japan
| | - Koji Todaka
- Center for Clinical and Translational Research (T.T., K. Tagawa, M.H., K.F., J.K., K. Todaka), Kyushu University Hospital, Fukuoka, Japan
| | - Naoki Nakashima
- Medical Information Center (N.N.), Kyushu University Hospital, Fukuoka, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine (T.T., T.I., M.I., T.N., K.S., H.T.), Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Dönmez E, Özcan S, Mert B, Özkaynak B, Tuğrul S, Şahin İ, Okuyan E. A Retrospective Study to Evaluate the Association Between the Glasgow Prognostic Score and Atrial Fibrillation, Stroke, and Mortality at 30 Days and at 1 Year After Coronary Artery Bypass Graft Surgery. Med Sci Monit 2023; 29:e939283. [PMID: 36718108 PMCID: PMC9898998 DOI: 10.12659/msm.939283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The Glasgow prognostic score (GPS) consists of a combination of serum C-reactive protein and albumin levels as indicators of systematic inflammatory response and nutritional status, respectively. The present retrospective study aimed to evaluate the association between the GPS and atrial fibrillation, stroke, and mortality at 30 days and 1 year after coronary artery bypass graft (CABG) surgery. MATERIAL AND METHODS Patients with chronic coronary syndromes who underwent CABG surgery between 2012 and 2019 in a single center were included. Preoperative GPS was calculated. Then, patients were grouped according to postoperative atrial fibrillation (POAF) development. Further, groups were formed to evaluate the relationship between GPS and 30-day and 1-year cardiovascular mortality as well as stroke development. RESULTS Patients who developed POAF had higher GPS, higher European System for Cardiac Operative Risk Evaluation (EuroSCORE II) score, advanced age, lower angiotensin converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use, lower left ventricular ejection fraction, and were more likely to be female and to have a history of carotid artery disease (P<0.05, for all). Additionally, GPS, EuroSCORE II, advanced age, and lower left ventricular ejection fraction were detected as independent risk factors for POAF development. When adverse outcomes were assessed, cardiovascular mortality at 30 days or 1 year, and stroke development at 1 year, were more frequent in patients with POAF. Moreover, POAF development was found to be an independent risk factor for adverse outcomes. Also, GPS was established as an independent risk factor both for 30-day and 1-year cardiovascular mortality (P<0.0001 and P=0.001, respectively). CONCLUSIONS GPS is an easy-to-calculate score that has reasonable diagnostic accuracy in determining the risk of POAF and stroke as well as 30-day and 1-year cardiovascular mortality.
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Affiliation(s)
- Esra Dönmez
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Sevgi Özcan
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Bülent Mert
- Department of Cardiovascular Surgery, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Berk Özkaynak
- Department of Cardiovascular Surgery, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Sevil Tuğrul
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - İrfan Şahin
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
| | - Ertuğrul Okuyan
- Department of Cardiology, Bagcilar Training and Research Hospital, İstanbul, Turkey
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25
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McIntyre WF. Post-operative atrial fibrillation after cardiac surgery: Challenges throughout the patient journey. Front Cardiovasc Med 2023; 10:1156626. [PMID: 36960472 PMCID: PMC10027741 DOI: 10.3389/fcvm.2023.1156626] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2023] Open
Abstract
Atrial fibrillation (AF) is the most common complication of cardiac surgery, occurring in up to half of patients. Post-operative AF (POAF) refers to new-onset AF in a patient without a history of AF that occurs within the first 4 weeks after cardiac surgery. POAF is associated with short-term mortality and morbidity, but its long-term significance is unclear. This article reviews existing evidence and research challenges for the management of POAF in patients who have had cardiac surgery. Specific challenges are discussed in four phases of care. Pre-operatively, clinicians need to be able to identify high-risk patients, and initiate prophylaxis to prevent POAF. In hospital, when POAF is detected, clinicians need to manage symptoms, stabilize hemodynamics and prevent increases in length of stay. In the month after discharge, the focus is on minimizing symptoms and preventing readmission. Some patients require short term oral anticoagulation for stroke prevention. Over the long term (2-3 months after surgery and beyond), clinicians need to identify which patients with POAF have paroxysmal or persistent AF and can benefit from evidence-based therapies for AF, including long-term oral anticoagulation.
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Fleet H, Pilcher D, Bellomo R, Coulson TG. Predicting atrial fibrillation after cardiac surgery: a scoping review of associated factors and systematic review of existing prediction models. Perfusion 2023; 38:92-108. [PMID: 34405746 DOI: 10.1177/02676591211037025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Postoperative atrial fibrillation (POAF) is common after cardiac surgery and associated with increased hospital length of stay, patient morbidity and mortality. We aimed to identify factors associated with POAF and evaluate the accuracy of available POAF prediction models. METHODS We screened articles from Ovid MEDLINE® and PubMed Central® (PMC) and included studies that evaluated risk factors associated with POAF or studies that designed or validated POAF prediction models. We only included studies in cardiac surgical patients with sample size n ⩾ 50 and a POAF outcome group ⩾20. We summarised factors that were associated with POAF and assessed prediction model performance by reviewing reported calibration and discriminative ability. RESULTS We reviewed 232 studies. Of these, 142 fulfilled the inclusion criteria. Age was frequently found to be associated with POAF, while most other variables showed contradictory findings, or were assessed in few studies. Overall, 15 studies specifically developed and/or validated 12 prediction models. Of these, all showed poor discrimination or absent calibration in predicting POAF in externally validated cohorts. CONCLUSIONS Except for age, reporting of factors associated with POAF is inconsistent and often contradictory. Prediction models have low discrimination, missing calibration statistics, are at risk of bias and show limited clinical applicability. This suggests the need for studies that prospectively collect AF relevant data in large cohorts and then proceed to validate findings in external data sets.
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Affiliation(s)
- Hugh Fleet
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - David Pilcher
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Parkville, VIC, Australia
| | - Tim G Coulson
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Parkville, VIC, Australia
- Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia
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27
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Yu MH, Zhang RJZ, Yu XY, Shi JW, Liu ZG. Association of LDL to HDL ratio with new-onset atrial fibrillation after on-pump coronary artery bypass graft surgery. BMC Cardiovasc Disord 2022; 22:564. [PMID: 36564701 PMCID: PMC9783402 DOI: 10.1186/s12872-022-03016-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE This study aims to analyze the association between preoperative LDL/HDL ratio and new-onset atrial fibrillation (AF) after on-pump coronary artery bypass grafting (on-pump CABG), evaluate the clinic value of preoperative LDL/HDL ratio to identify postoperative rhythm. METHODS A retrospective study of consecutive patients (n = 2052) who underwent on-pump CABG at TEDA International Cardiovascular Hospital (Tianjin, China), from June 1, 2020, to December 30, 2021, was conducted. The association between preoperative LDL/HDL and new-onset POAF was analyzed by Lowess curve and univariate logistic regression. The receiver operating characteristic curve (ROC) and area under the curve (AUC) were used to evaluate the identification capacity of preoperative LDL/HDL level for new-onset POAF. RESULTS In studied populations, the incidence of new-onset POAF was about 29.24%. The lowess curve showed that the association between preoperative LDL/HDL ratio and POAF after on-pump CABG was similar to a linear relationship. With the increasement of preoperative LDL/HDL ratio, the incidence of POAF increased simultaneously. ROC analysis showed that preoperative LDL/HDL ratio could identify postoperative arrhythmia after on-pump CABG (AUC = 0.569,95% CI = 0.529-0.608, P = 0.006) among female patients, the best preoperative LDL/HDL ratio cutoff of 2.11, which was considered a predictive factor of incident POAF, showed a sensitivity of 83.60% (95% CI = 0.775-0.886) and a specificity of 30.02% (95% CI = 0.257-0.346). CONCLUSION Preoperative LDL/HDL ratio is associated with new-onset POAF, but there is a difference in different sex. Preoperative LDL/HDL level can help to identify postoperative rhythm in females.
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Affiliation(s)
- Ming-Huan Yu
- grid.478012.8Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Graduate School of Peking Union Medical College, 61, Third Avenue, TEDA, Tianjin, China
| | - Ren-Jian-Zhi Zhang
- grid.478012.8Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Graduate School of Peking Union Medical College, 61, Third Avenue, TEDA, Tianjin, China
| | - Xin-Yi Yu
- grid.478012.8Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Graduate School of Peking Union Medical College, 61, Third Avenue, TEDA, Tianjin, China
| | - Jian-Wei Shi
- grid.478012.8Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Graduate School of Peking Union Medical College, 61, Third Avenue, TEDA, Tianjin, China
| | - Zhi-Gang Liu
- grid.478012.8Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Chinese Academy of Medical Sciences and Graduate School of Peking Union Medical College, 61, Third Avenue, TEDA, Tianjin, China
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Bai C, Liu Y, Zhao Y, Ye Q, Zhao C, Liu Y, Wang J. Circulating exosome-derived miR-122-5p is a novel biomarker for prediction of postoperative atrial fibrillation. J Cardiovasc Transl Res 2022; 15:1393-1405. [PMID: 35513595 DOI: 10.1007/s12265-022-10267-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/21/2022] [Indexed: 12/16/2022]
Abstract
Postoperative atrial fibrillation (POAF) is a frequent complication associated with increased periprocedural mortality and morbidity after cardiac surgery. Our study aimed to identify the difference in exosomal miRNA and further explore its role in the diagnosis of POAF. First, the differentially expressed miRNAs (DEMs) were obtained by high-throughput RNA sequencing. Second, the DEMs target genes were put into gene ontology (GO) and KEGG pathway analysis. Third, real-time quantification PCR (RT-qPCR) was used to verify the DEMs. Finally, we revealed 23 DEMs in POAF patients. Furthermore, analysis of gene function revealed that DEMs may affect atrial structure through many signaling pathways. We also found that miR-122-5p was up-regulated in POAF patients, but there are no significant changes in miR-191-5p, miR-181a-5p, miR-155-5p and miR-151a-5p. Our study revealed that exosomal miRNAs exert enormous potential in evaluating the severity or prognostic of POAF.
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Affiliation(s)
- Chen Bai
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yisi Liu
- School of Nursing, Capital Medical University, Beijing, 100069, China
| | - Yichen Zhao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Qing Ye
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Cheng Zhao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jiangang Wang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
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Yang H, Yuan C, Yang J, Xiang H, Lan W, Tang Y. A novel predictive model for new-onset atrial fibrillation in patients after isolated cardiac valve surgery. Front Cardiovasc Med 2022; 9:949259. [PMID: 36247462 PMCID: PMC9556269 DOI: 10.3389/fcvm.2022.949259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostoperative atrial fibrillation (POAF) is a severe complication after cardiac surgery and is associated with an increased risk of ischemic stroke and mortality. The main aim of this study was to identify the independent predictors associated with POAF after isolated valve operation and to develop a risk prediction model.MethodsThis retrospective observational study involved patients without previous AF who underwent isolated valve surgery from November 2018 to October 2021. Patients were stratified into two groups according to the development of new-onset POAF. Baseline characteristics and perioperative data were collected from the two groups of patients. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors for the occurrence of POAF, and the results of the multivariate analysis were used to create a predictive nomogram.ResultsA total of 422 patients were included in the study, of which 163 (38.6%) developed POAF. The Multivariate logistic regression analysis indicated that cardiac function (odds ratio [OR] = 2.881, 95% confidence interval [CI] = 1.595–5.206; P < 0.001), Left atrial diameter index (OR = 1.071, 95%CI = 1.028–1.117; P = 0.001), Operative time (OR = 1.532, 95%CI = 1.095–2.141; P = 0.013), Neutrophil count (OR = 1.042, 95%CI = 1.006–1.08; P = 0.021) and the magnitude of fever (OR = 3.414, 95%CI = 2.454–4.751; P < 0.001) were independent predictors of POAF. The above Variables were incorporated, and a nomogram was successfully constructed with a C-index of 0.810. The area under the receiver operating characteristic curve was 0.817.ConclusionCardiac function, left atrial diameter index, operative time, neutrophil count, and fever were independent predictors of POAF in patients with isolated valve surgery. Establishing a nomogram model based on the above predictors helps predict the risk of POAF and may have potential clinical utility in preventive interventions.
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Affiliation(s)
- Heng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Chen Yuan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Juesheng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haiyan Xiang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wanqi Lan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Yanhua Tang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yanhua Tang,
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Gong J, Wei Y, Zhang Q, Tang J, Chang Q. Nomogram predicts atrial fibrillation after coronary artery bypass grafting. BMC Cardiovasc Disord 2022; 22:388. [PMID: 36042409 PMCID: PMC9429785 DOI: 10.1186/s12872-022-02824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/16/2022] [Indexed: 11/12/2022] Open
Abstract
Objective Using the nomogram to intuitively predict atrial fibrillation after coronary artery bypass grafting. Identify high-risk patients with atrial fibrillation and provide preoperative protective therapy. Methods A total of 397 patients that underwent coronary artery bypass grafting were consecutively enrolled. Independent predictors of patients were analyzed by multivariate logistic regression. Two nomograms were constructed to predict postoperative atrial fibrillation. Results The incidence of postoperative atrial fibrillation in this study was 29% (115/397). Multivariate Logistic showed that Age, Operative Time > 4 h, Left Atrial Diameter > 40 mm, Mean Arterial Pressure, Body Mass Index > 23 kg/m2, Insulins, and Statins were independently associated with atrial fibrillation after isolated coronary artery bypass grafting. The nomogram of postoperative atrial fibrillation in patients was constructed using total predictor variables (AUC = 0.727, 95% CI 0.673–0.781). The model was internally validated (AUC = 0.701) by K-fold Cross-validation resampling (K = 5, Times = 400). To make an early intervention, the intraoperative information of the patients was excluded. Only 6 variables before surgery were used to establish the brief nomogram to predict postoperative atrial fibrillation (AUC = 0.707, 95% CI 0.651–0.764). The brief model was internally validated (AUC = 0.683) by resampling with K-fold Cross-validation resampling. Conclusions These two nomograms could be used to predict patients at high risk for atrial fibrillation after isolated coronary artery bypass grafting.
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Affiliation(s)
- Jingshuai Gong
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Yangyan Wei
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Qian Zhang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Jiwen Tang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China
| | - Qing Chang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangsu Road, Qingdao, 266003, China.
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Genovesi S, Regolisti G, Burlacu A, Covic A, Combe C, Mitra S, Basile C. The conundrum of the complex relationship between acute kidney injury and cardiac arrhythmias. Nephrol Dial Transplant 2022; 38:1097-1112. [PMID: 35777072 DOI: 10.1093/ndt/gfac210] [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: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Acute kidney injury (AKI) is defined by a rapid increase in serum creatinine levels, reduced urine output, or both. Death may occur in 16%-49% of patients admitted to an intensive care unit with severe AKI. Complex arrhythmias are a potentially serious complication in AKI patients with pre-existing or AKI-induced heart damage and myocardial dysfunction, fluid overload, and especially electrolyte and acid-base disorders representing the pathogenetic mechanisms of arrhythmogenesis. Cardiac arrhythmias, in turn, increase the risk of poor renal outcomes, including AKI. Arrhythmic risk in AKI patients receiving kidney replacement treatment may be reduced by modifying dialysis/replacement fluid composition. The most common arrhythmia observed in AKI patients is atrial fibrillation. Severe hyperkalemia, sometimes combined with hypocalcemia, causes severe bradyarrhythmias in this clinical setting. Although the likelihood of life-threatening ventricular arrhythmias is reportedly low, the combination of cardiac ischemia and specific electrolyte or acid-base abnormalities may increase this risk, particularly in AKI patients who require kidney replacement treatment. The purpose of this review is to summarize the available epidemiological, pathophysiological, and prognostic evidence aiming to clarify the complex relationships between AKI and cardiac arrhythmias.
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Affiliation(s)
- Simonetta Genovesi
- School of Medicine and Surgery, University of Milano - Bicocca, Nephrology Clinic, Monza, Italy.,Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Giuseppe Regolisti
- Clinica e Immunologia Medica -Azienda Ospedaliero-Universitaria e Università degli Studi di Parma, Parma, Italy
| | - Alexandru Burlacu
- Department of Interventional Cardiology - Cardiovascular Diseases Institute, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Adrian Covic
- Nephrology Clinic, Dialysis, and Renal Transplant Center - 'C.I. Parhon' University Hospital, and 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, and Unité INSERM 1026, Université de Bordeaux, Bordeaux, France
| | - Sandip Mitra
- Department of Nephrology, Manchester Academy of Health Sciences Centre, Manchester University Hospitals Foundation Trust, Oxford Road, Manchester, UK
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy
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Koçyiğit M, Koçyiğit ÖI, Güllü AÜ, Şenay Ş, Alhan C. Postoperative Atrial Fibrillation Reduced by Intraoperative and Postoperative Cell Saver System in Coronary Artery Bypass Graft Surgery. Turk J Anaesthesiol Reanim 2022; 50:173-177. [PMID: 35801322 PMCID: PMC9361126 DOI: 10.5152/tjar.2022.21121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Postoperative atrial fibrillation is commonly seen after cardiac surgery. One of the contributing factors is mediastinal shed blood and inflammation. Cell salvage techniques can reduce allogenic blood transfusion and reduce inflammation. The aim of this study was to investigate the reduction of postoperative atrial fibrillation by using the cell-salvage system. METHODS Patients who underwent isolated coronary artery bypass graft surgery (n = 498) were analyzed retrospectively in 2 groups. Postoperative atrial fibrillation group (n = 75) and non-postoperative atrial fibrillation group (n = 423). Preoperative and postoperative demographic and clini- cal data were compared between the 2 groups, respectively. Postoperative atrial fibrillation and possible contributing factors were analyzed with multinomial logistic regression analysis. RESULTS In the postoperative atrial fibrillation group, the patients' age and European System for Cardiac Operative Risk Evaluation (Euroscore) were higher than in the non-postoperative atrial fibrillation group (P = .001 and P = .003, respectively). Postoperative intensive care unit stay and hospital stay were longer in the postoperative atrial fibrillation group than in the non-postoperative atrial fibrillation group (P = .001 and P = .046, respectively). There were no statistical differences in mortality between groups. The incidence of postoperative atrial fibrillation decreased with the use of cell saver system and low Euroscore. CONCLUSION The use of a cell salvage device intraoperatively and during the early postoperative period can decrease the incidence of postop- erative atrial fibrillation group.
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Affiliation(s)
- Muharrem Koçyiğit
- Department of Anaesthesiology, Acıbadem Mehmet Ali Aydınlar University Vocational School of Health Services, İstanbul, Turkey
| | - Özgen Ilgaz Koçyiğit
- Department of Anaesthesiology, Acıbadem Mehmet Ali Aydınlar University Vocational School of Health Services, İstanbul, Turkey
| | - Ahmet Ümit Güllü
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Şahin Şenay
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
| | - Cem Alhan
- Department of Cardiovascular Surgery, Acıbadem Mehmet Ali Aydınlar University Faculty of Medicine, İstanbul, Turkey
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Ortega-Martorell S, Pieroni M, Johnston BW, Olier I, Welters ID. Development of a Risk Prediction Model for New Episodes of Atrial Fibrillation in Medical-Surgical Critically Ill Patients Using the AmsterdamUMCdb. Front Cardiovasc Med 2022; 9:897709. [PMID: 35647039 PMCID: PMC9135978 DOI: 10.3389/fcvm.2022.897709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
The occurrence of atrial fibrillation (AF) represents clinical deterioration in acutely unwell patients and leads to increased morbidity and mortality. Prediction of the development of AF allows early intervention. Using the AmsterdamUMCdb, clinically relevant variables from patients admitted in sinus rhythm were extracted over the full duration of the ICU stay or until the first recorded AF episode occurred. Multiple logistic regression was performed to identify risk factors for AF. Input variables were automatically selected by a sequential forward search algorithm using cross-validation. We developed three different models: For the overall cohort, for ventilated patients and non-ventilated patients. 16,144 out of 23,106 admissions met the inclusion criteria. 2,374 (12.8%) patients had at least one AF episode during their ICU stay. Univariate analysis revealed that a higher percentage of AF patients were older than 70 years (60% versus 32%) and died in ICU (23.1% versus 7.1%) compared to non-AF patients. Multivariate analysis revealed age to be the dominant risk factor for developing AF with doubling of age leading to a 10-fold increased risk. Our logistic regression models showed excellent performance with AUC.ROC > 0.82 and > 0.91 in ventilated and non-ventilated cohorts, respectively. Increasing age was the dominant risk factor for the development of AF in both ventilated and non-ventilated critically ill patients. In non-ventilated patients, risk for development of AF was significantly higher than in ventilated patients. Further research is warranted to identify the role of ventilatory settings on risk for AF in critical illness and to optimise predictive models.
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Affiliation(s)
- Sandra Ortega-Martorell
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- *Correspondence: Sandra Ortega-Martorell,
| | - Mark Pieroni
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Brian W. Johnston
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Ivan Olier
- School of Computer Science and Mathematics, Liverpool John Moores University, Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
| | - Ingeborg D. Welters
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Ingeborg D. Welters,
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Potdar SP, Shales S, Baviskar M, Sharma M, Kapoor L, Narayan P. Incidence, predictors, and outcome for post-operative atrial fibrillation in Indian patients undergoing off-pump coronary artery bypass grafting—a prospective observational study. Indian J Thorac Cardiovasc Surg 2022; 38:366-374. [DOI: 10.1007/s12055-022-01358-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022] Open
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Zand M, Sattarzadeh R, Larti F, Mansouri P, Tavoosi A. Right ventricular diastolic function predicts clinical atrial fibrillation after coronary artery bypass graft. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:35. [PMID: 35968213 PMCID: PMC9374141 DOI: 10.4103/jrms.jrms_816_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 06/07/2020] [Accepted: 11/25/2021] [Indexed: 11/04/2022]
Abstract
Background Patients with moderate-severe left ventricular systolic dysfunction undergoing coronary artery bypass graft (CABG) surgery are at high risk of mortality and morbidity. Our aim is to evaluate the right ventricular (RV) diastolic function in these patients, and monitor its effects on postoperation outcomes. Materials and Methods In a cohort study, patients with moderate-severe left ventricular systolic dysfunction (ejection fraction ≤35%) who were candidate for CABG were included. Baseline transthoracic echocardiography (TTE) was performed, and RV diastolic function measures were obtained. After CABG, the length of intubation, inotrope dependency, hospital stay in intensive care unit and ward, in-hospital and after discharge mortality, postoperative atrial fibrillation (POAF) were evaluated in all patients. Results Sixty-seven patients were prospectively included in the study. The mean ± standard deviation age of our patients was 61.4 ± 9.3. There was no difference between grades of RV diastolic function and postoperative outcomes. However, we found significant difference between grades of RV diastolic function and onset of in hospital, and total POAF (P-value = 0.017). Multivariate analysis demonstrated that preoperative tricuspidEt/E't (ratio of peak early-diastolic flow rate across the tricuspid valve orifice to peak early-diastolic velocity at the lateral tricuspid annulus), left atrial volume and "high risk" Euroscore II were independent predictors for POAF during hospitalization and total POAF in patients with moderate to severely impaired left ventricular systolic function (P-values were 0.04, 0.003 and 0.001, respectively). Conclusion We believe that patients with increased tricuspid Et/E't are high risk for POAF; therefore, any risk score for POAF should include a comprehensive TTE including evaluation of RV diastolic function before surgery.
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Affiliation(s)
- Mehdi Zand
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Roya Sattarzadeh
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Farnoosh Larti
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Pejman Mansouri
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Tavoosi
- Department of Cardiology, Imam Khomeini Complex, Tehran University of Medical Sciences, Tehran, Iran
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Kurniawaty J, Setianto BY, Supomo, Widyastuti Y, Boom CE. The Effect of Low Preoperative Ejection Fraction on Mortality After Cardiac Surgery in Indonesia. Vasc Health Risk Manag 2022; 18:131-137. [PMID: 35356550 PMCID: PMC8959716 DOI: 10.2147/vhrm.s350671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Among cardiac surgery patients, low preoperative left ventricular ejection fraction (LVEF) is common and has been associated with poor outcomes. The objective of this study was to assess the association between LVEF and postoperative mortality in patients undergoing open-heart surgery in several hospitals in Indonesia. Methods We conducted a multicenter study with the retrospective design using data from patients undergoing open-heart surgery in 4 institutions in Indonesia. Data regarding LVEF and other potential risk factors were extracted from medical records and compiled in one datasheet. Statistical analyses were performed to assess if low LVEF was associated with postoperative mortality and identify other potential risk factors. Results A total of 4789 patients underwent cardiac surgery in participating centers during the study period. Of these, 189 subjects (3.9%) had poor preoperative LVEF. Poor LVEF was associated with postoperative mortality (adjusted OR 2.761, 95% CI 1.763–4.323, p < 0.001). Based on types of surgery, LVEF had a significant association with mortality only in CABG patients, while there was no such association in valve surgery and inconclusive in congenital surgery patients. Other significant independent predictors of in-hospital mortality included age more than 65 years old, non-elective surgery, the complexity of procedures, history of cardiac surgery, organ failure, CARE score ≥ 3, NYHA class ≥ III, and poor right ventricular function. Conclusion Patients with low preoperative LVEF undergoing open-heart surgery had a higher risk of postoperative mortality. Cardiac surgery can be performed with acceptable mortality rates. Accurate selection of patients, risk/benefit evaluation, and planning of surgical and anesthesiological management are mandatory to improve outcomes.
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Affiliation(s)
- Juni Kurniawaty
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Budi Yuli Setianto
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Supomo
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yunita Widyastuti
- Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Cindy E Boom
- Harapan Kita National Heart Center, Jakarta, Indonesia
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Jadhav KP, Pai PG, Nair I, Krishnan S, Varma PK. Role of fibroblast growth factor-23 (FGF-23) in the prediction of postoperative atrial fibrillation after coronary artery bypass surgery. Indian J Thorac Cardiovasc Surg 2022; 38:251-261. [PMID: 35529001 PMCID: PMC9023647 DOI: 10.1007/s12055-021-01328-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Fibroblast growth factor-23 (FGF-23) is a bone-derived hormone which had shown a significant association with the occurrence of atrial fibrillation (AF) in patients with chronic kidney disease. We hypothesized that FGF-23 could be a very useful predictive biomarker for atrial remodeling and in turn for postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). We also looked at the correlation of cardiac remodeling in right atrial biopsy and its correlation with POAF and with the FGF-23 level. Methods This study was a single-center cross-sectional observational study. All the patients who were planned for CABG with no prior history of AF were included in the study. All the patients were tested for preoperative serum FGF-23 level. During CABG, biopsy specimen of the right atrial appendage was sent for histopathology evaluation. All patients were monitored for POAF until discharge from the hospital. Results This study involved 60 patients who underwent elective CABG. Multivariate analysis revealed a significant association between preoperative FGF-23 levels with the occurrence of POAF (p < 0.001). The area under the curve of FGF-23 was 0.894 with a sensitivity of 92.3% and specificity of 87.23%. The cut-off value for serum FGF-23 levels was found to be 6.50 ng/ml. Analysis of biopsy specimens revealed that the presence of hypertrophic myocytes had a significant association with the occurrence of POAF/POAE and with FGF-23. Conclusion Preoperative FGF-23 levels can predict the incidence of POAF in post-CABG patients. Histopathologically, the presence of hypertrophic myocytes correlated well with the occurrence of POAF.
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Affiliation(s)
- Kartik Pandurang Jadhav
- Yashoda Hospital, Somajiguda, Telangana 500082 India
- Amrita Institute of Medical Sciences, Former Senior Resident, Kerala Kochi, India
| | | | - Indu Nair
- Department of Pathology, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Sajitha Krishnan
- Department of Biochemistry, Amrita Institute of Medical Sciences, Kochi, Kerala India
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Shvartz V, Sokolskaya M, Petrosyan A, Ispiryan A, Donakanyan S, Bockeria L, Bockeria O. Predictors of Mortality Following Aortic Valve Replacement in Aortic Stenosis Patients. PATHOPHYSIOLOGY 2022; 29:106-117. [PMID: 35366293 PMCID: PMC8955830 DOI: 10.3390/pathophysiology29010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Understanding of the risk factors for the development of adverse outcomes after aortic valve replacement is necessary to develop timely preventive measures and to improve the results of surgical treatment. Methods: We analyzed patients with aortic stenosis (n = 742) who underwent surgical treatment in the period 2014−2020. The average age was 63 (57;69) years—men 58%, women 42%. Results: The hospital mortality rate was 3% (22 patients). The following statistically significant threshold values (cut-off points) were obtained in the ROC analysis: aortic cross-clamp time > 93 min AUC (CI) 0.676 (0.640−0.710), p = 0.010; cardiopulmonary bypass time > 144 min AUC (CI) 0.809 (0.778−0.837), p < 0.0001, hemoglobin before op <120 g/L. AUC (CI) 0.762 (0.728−0.793), p < 0.0001, hematocrit before op <39% AUC (CI) 0.755 (0.721−0.786), p < 0.001, end-diastolic dimension index >2.39 AUC (CI) 0.647 (0.607−0.686), p = 0.014, end-systolic dimension index > 1.68 AUC (CI) 0.657 (0.617−0.695), p = 0.009. Statistically significant independent predictors of hospital mortality were identified: BMI > 30 kg/m2 (OR 2.84; CI 1.15−7.01), ischemic heart disease (OR 3.65; CI 1.01−13.2), diabetes (OR 3.88; CI 1.38−10.9), frequent ventricular ectopy before operation (OR 9.78; CI 1.91−50.2), mitral valve repair (OR 4.47; CI 1.76−11.3), tricuspid valve repair (OR 3.06; CI 1.09−8.58), 3 and more procedures (OR 4.44; CI 1.67−11.8). Conclusions: The hospital mortality rate was 3%. The main indicators associated with the risk of death were: diabetes, overweight (body mass index more than 30 kg/m2), frequent ventricular ectopy before surgery, hemoglobin level below 120 g/L, hematocrit level below 39%, longer cardiopulmonary bypass time and aortic cross-clamp time, additional mitral and tricuspid valve interventions.
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Zhu Y, Jing W, Lv P, Zhu Y, Liu Z. Clinical factors associated with arrhythmia and short-term prognosis following mitral valve repair: a retrospective cohort study. Cardiovasc Diagn Ther 2022; 12:114-122. [PMID: 35282674 PMCID: PMC8898689 DOI: 10.21037/cdt-21-400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/25/2021] [Indexed: 01/18/2024]
Abstract
BACKGROUND Postoperative arrhythmia (POA) is one of the common and serious postoperative complications. This retrospective study was conducted to investigate the clinical factors associated with POA and its short-term prognosis following mitral valve repair. METHODS A total of 618 patients receiving mitral valve repair between January 2015 and November 2020 in our hospital were included in this retrospective study, including 318 males and 300 females and aged 53.9±9.3 years. The patients were grouped into arrhythmia and non-arrhythmia groups and investigated for risk factors associated with the prognosis of POA using multivariate logistic regression based on their clinical data. RESULTS POA was observed in 314 (50.8%) patients and atrial fibrillation (AF) was the most frequent (43.3%) type of POA. Compared with non-arrhythmia patients, arrhythmia patients had significantly longer time to use vasoactive drug use, longer intensive care unit (ICU) stay and longer hospital stay. In addition, the incidence of postoperative heart failure was significantly higher (P<0.05). Logistic regression analysis showed that preoperative arrhythmia [odds ratio (OR) =9.17; 95% confident interval (CI): 4.49-18.10], postoperative pain (OR =4.70; 95% CI: 1.55-6.12) and postoperative hypoxemia (OR =3.25; 95% CI: 1.04-6.28) were independently associated with POA. CONCLUSIONS This study demonstrates that the incidence of arrhythmia is relatively high after mitral valve repair and is associated with preoperative arrhythmia, postoperative pain and postoperative hypoxemia.
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Affiliation(s)
- Yuxiang Zhu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Wenbin Jing
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Pengfei Lv
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Yubao Zhu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
| | - Zhigang Liu
- Department of Cardiovascular Surgery, TEDA International Cardiovascular Hospital, Tianjin, China
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Fan K, Chen L, Liu F, Ding X, Yan P, Gao M, Yu W, Liu H, Yu Y. Predicting New-Onset Postoperative Atrial Fibrillation Following Isolated Coronary Artery Bypass Grafting: Development and Validation of a Novel Nomogram. Int J Gen Med 2022; 15:937-948. [PMID: 35115819 PMCID: PMC8801512 DOI: 10.2147/ijgm.s346339] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/07/2022] [Indexed: 01/23/2023] Open
Abstract
Objective To select variables associated with new-onset postoperative atrial fibrillation (POAF) following isolated coronary artery bypass grafting (CABG) and develop a nomogram for risk prediction in a Chinese population. Methods The study retrospectively enrolled 4854 consecutive patients undergoing isolated CABG from February 2018 to September 2019, they were divided into derivation cohort and validation cohort with a 3:1 ratio according to the order of operation date. In the derivation cohort, significant variables were selected by use of the multivariate logistic backward stepwise regression analysis and a nomogram model was built on the strength of the results. The model performance was assessed in terms of discrimination and calibration. Besides, we compared the discriminative ability for POAF of the nomogram with established prediction models (CHA2DS2-VASc and HATCH scores) in the two cohorts. Results POAF occurred in 1025 (28.2%) out of 3641 patients in the derivation cohort, and in 337 (27.8%) out of 1213 patients in the validation cohort. A nomogram, composed of eight prognostic variables, namely age, sex, heart rate, hypertension, left ventricular ejection fraction (LVEF) <50%, left atrial diameter (LAD) > 40mm, estimated glomerular filtration rate (eGFR) level, and on-pump surgery, was constructed from the derivation cohort. The nomogram had substantial discriminative ability in derivation and validation cohorts with the area under the receiver operating characteristic curves (AUCs) of 0.661 (95% confidence interval, 0.642–0.681) and 0.665 (95% confidence interval, 0.631–0.699), respectively, and showed well-fitted calibration curves. Compared with CHA2DS2-VASc, HATCH and POAF scores, respectively, the nomogram had superior discrimination performance. Conclusion We constructed a novel nomogram with improved accuracy for predicting the risk of POAF following isolated CABG, which might help clinicians predict individual probability of POAF and achieve effective prophylaxis.
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Affiliation(s)
- Kangjun Fan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Liang Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Fei Liu
- Department of Biology, Faculty of Science, Hong Kong Baptist College, Kowloon Tong, Hong Kong, People’s Republic of China
| | - Xiaohang Ding
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Pengyun Yan
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Mingxin Gao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Wenyuan Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Hongli Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
| | - Yang Yu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People’s Republic of China
- Correspondence: Yang Yu, Tel +86-10-64456868, Fax +86-10-84005030, Email
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Arslan AK, Erdil N, Guldogan E, Colak C, Akca B, Colak MC. Prediction of Postcoronary Artery Bypass Grafting Atrial Fibrillation: POAFRiskScore Tool. Thorac Cardiovasc Surg 2021; 71:282-290. [PMID: 34894632 DOI: 10.1055/s-0041-1736245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Atrial fibrillation (AF), a condition that might occur after a heart bypass procedure, has caused differing estimates of its occurrence and risk. The current study analyses the possible risk factors of post-coronary artery bypass grafting (post-CABG) AF (postoperative AF [POAF]) and presents a software for preoperative POAF risk prediction. METHODS This retrospective research was performed on 1,667 patients who underwent CABG surgery using the hospital database. The associations between the variables of the patients and AF risk factors after CABG were examined using multivariable logistic regression (LR) after preprocessing the relevant data. The tool was designed to predict POAF risk using Shiny, an R package, to develop a web-based software. RESULTS The overall proportion of post-CABG AF was 12.2%. According to the results of univariate tests, in terms of age (p < 0.001), blood urea nitrogen (p = 0.005), platelet (p < 0.001), triglyceride (p = 0.0026), presence of chronic obstructive pulmonary disease (COPD; p = 0.01), and presence of preoperative carotid artery stenosis (PCAS; p < 0.001), there were statistically significant differences between the POAF and non-POAF groups. Multivariable LR analysis disclosed the independent risk factors associated with POAF: PCAS (odds ratio [OR] = 2.360; p = 0.028), COPD (OR = 2.243; p = 0.015), body mass index (OR = 1.090; p = 0.006), age (OR = 1.054, p < 0.001), and platelet (OR = 0.994, p < 0.001). CONCLUSION The experimental findings from the current research demonstrate that the suggested tool (POAFRiskScore v.1.0) can help clinicians predict POAF risk development in the preoperative period after validated on large sample(s) that can represent the related population(s). Simultaneously, since the updated versions of the proposed tool will be released periodically based on the increases in data dimensions with continuously added new samples and related factors, more robust predictions may be obtained in the subsequent stages of the current study in statistical and clinical terms.
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Affiliation(s)
- Ahmet Kadir Arslan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Nevzat Erdil
- Department of Cardiovascular Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Emek Guldogan
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - Baris Akca
- Department of Cardiovascular Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - M Cengiz Colak
- Department of Cardiovascular Surgery, Faculty of Medicine, Inonu University, Malatya, Turkey
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Waterford SD, Ad M. 7 Pillars of Postoperative Atrial Fibrillation Prevention. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:498-503. [PMID: 34823388 DOI: 10.1177/15569845211043485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Stephen D Waterford
- 12302 Division of Cardiac Surgery, Department of Surgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Michal Ad
- 23146 Department of Surgery, Inova Fairfax Hospital, Falls Church, VA, USA
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Semeraro GC, Meroni CA, Cipolla CM, Cardinale DM. Atrial Fibrillation after Lung Cancer Surgery: Prediction, Prevention and Anticoagulation Management. Cancers (Basel) 2021; 13:cancers13164012. [PMID: 34439166 PMCID: PMC8394120 DOI: 10.3390/cancers13164012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/03/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Atrial fibrillation that occurs after surgery raises further questions with respect to spontaneous atrial fibrillation, being an event unquestionably related to the surgical act itself and always quite self-limiting. The purpose of this review is to present the knowledge gained so far, including the most recent findings, regarding this peculiar form of arrhythmia. Its prognostic impact and the possibility of predicting and preventing it were the subject of our analysis, as well as the similarities and differences with spontaneous atrial fibrillation in relation to anticoagulation. Where possible, the search for evidence has focused on studies involving lung cancer patients undergoing thoracic surgery, highlighting any differences with cardiac surgery. Abstract Atrial fibrillation (AF) is a common complication of the early postoperative period of various types of surgery, including that for lung cancer. Although induced by the homeostatic alterations related to surgery, there is evidence that it is not a mere stand-alone transitory event, but it represents a relevant complication of surgery, bearing considerable prognostic consequences. Different methods have therefore been explored to predict the occurrence of postoperative atrial fibrillation (POAF) and prevent it. In particular, the age among clinical factors, and N-terminal prohormone of brain natriuretic peptide (NT-proBNP), as a marker, have proven to be good predictors, and the use of beta-blockers or amiodarone in primary prevention seems to reduce its incidence significantly. There is growing evidence that POAF significantly increases the risk of stroke and global mortality in the long term; therefore, it should be managed in the same way as spontaneous atrial fibrillation. In this review, we will present the strongest evidence found so far and the most recent findings regarding the management of POAF, with a special focus on patients undergoing thoracic surgery for lung cancer.
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Affiliation(s)
| | - Carlo Ambrogio Meroni
- Cardiology Department, European Institute of Oncology, IRCCS, 20145 Milan, MI, Italy
| | - Carlo Maria Cipolla
- Cardiology Department, European Institute of Oncology, IRCCS, 20145 Milan, MI, Italy
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Abdelrazek G, Mandour K, Osama M, Elkhashab K. Strain and strain rate echocardiographic imaging predict occurrence of atrial fibrillation in post-coronary artery bypass grafting patients. Egypt Heart J 2021; 73:62. [PMID: 34216305 PMCID: PMC8254834 DOI: 10.1186/s43044-021-00188-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) occurs very frequently after coronary artery bypass grafting (CABG); it occurs in about 20-edictors can be used for the dedicatio40% of patients. It is associated with several adverse events. This study aimed to extrapolate a predictor for postoperative atrial fibrillation (POAF) occurrence which is reproducible and simple to be a part of routine echocardiography screening before CABG. This study included 89 patients scheduled for isolated coronary artery bypass surgery. History, clinical examination, and complete 2D echocardiography with LA speckle tracking analysis were done preoperatively. Patients were then followed up post-surgery for incidence of AF till discharge from the hospital. The patients were divided into 2 groups according to POAF occurrence. RESULTS Patients who developed postoperative AF had older age (P = 0.0032) and longer hospital stay (P = 0.021) and higher stroke incidence but statistically non-significant (14.3% vs 3.3%). The POAF patients showed less peak atrial longitudinal strain (PALS) value than non-POAF patients. The left atrial strain rate values showed a significant difference with the lower left atrial systolic strain rate and less negative (higher) early diastolic strain rate and late diastolic strain rate. After multivariate logistic regression analysis, the independent predictors for POAF were PALS (OR 0.770, 95% CI 0.627-0.946), late LA diastolic strain rate (LASRa) (OR 3.476, 95% CI 1.207-12.186), and age (OR 1.181, 95% CI 1.011-1.379). CONCLUSION Preoperative LA global strain assessed by 2D speckle tracking analysis could be helpful as a predictor for AF post-CABG surgery, and identification of these patients may reduce its morbidity and mortality. The study suggested PALS value less than 29.8 to be a predictor for the occurrence of POAF.
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Affiliation(s)
- Gomaa Abdelrazek
- Cardiology Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt.
| | | | | | - Khaled Elkhashab
- Cardiology Department, Faculty of Medicine, Fayoum University, Faiyum, Egypt
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45
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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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Hung LT, Alshareef A, Al-Ahdal TMA, Anh PTT, Huan DQ, Do Van Trang, Zia S, Van Sy H, Huy NT. Predicting atrial fibrillation after cardiac surgery using a simplified risk index. J Electrocardiol 2021; 67:45-49. [PMID: 34023539 DOI: 10.1016/j.jelectrocard.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/11/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and can lead to increased risk of postoperative adverse events. However, atrial fibrillation and postoperative adverse events are preventable. In this study, a risk index was developed to predict atrial fibrillation after cardiac surgery. METHODS A prospective cohort study of 405 patients who had undergone adult cardiac surgery from 2015 September to 2016 August at Heart Institute of HCMC and Cho Ray Hospital were obtained. In order to predict POAF, a logistic regression model was developed, and a risk score was derived and validated by bootstrap. RESULTS In our study, 98 patients developed POAF (24.2%). The risk score included three significant risk factors (age ≥ 60, left atrial diameter > 41 mm, Coronary Artery Bypass Graft with concomitant mitral valve replacement or repair) that were consistent with other reports. Each of these risk factors was assigned one point. The total risk score ranges from 0 to 3 (AUC = 0.69, 95% CI: 0.63-0.75) with the best cutoff point at 1. According to this scoring system, the incidences of POAF in patients associated with each score of 0, 1, 2, and 3 were 8.6%, 30.1%, 40.8%, and 58.3% respectively. Bootstrapping with 5000 samples confirmed the final model provided was consistent with predictions. CONCLUSIONS We developed and validated a simple risk score based on clinical variables that can be obtained before surgery in order to accurately predict the risk of POAF in patients undergoing cardiac surgery.
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Affiliation(s)
- Le Thanh Hung
- Heart Institute, Ho Chi Minh City, Viet Nam; Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan.
| | - Abdulmueti Alshareef
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; Faculty of Medicine, University of Zawia, AZ zawiyah, Libya.
| | - Tareq Mohammed Ali Al-Ahdal
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Jordan.
| | | | | | | | - Sairah Zia
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; American University of the Caribbean Medical School, Cupe Coy, Sint Maarten
| | - Hoang Van Sy
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Ho Chi Minh City, Viet Nam; Internal Cardiology Department of Cho Ray Hospital, Viet Nam.
| | - Nguyen Tien Huy
- Online Research Club (http://www.onlineresearchclub.org), Nagasaki, Japan; School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki 852-8523, Japan.
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Turkkolu ST, Selçuk E, Köksal C. Biochemical predictors of postoperative atrial fibrillation following cardiac surgery. BMC Cardiovasc Disord 2021; 21:167. [PMID: 33836659 PMCID: PMC8033715 DOI: 10.1186/s12872-021-01981-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
Background New-onset postoperative atrial fibrillation (POAF) is common after cardiac surgery. Early identification of its risk factors during the preoperative period would help in reducing the associated morbidity, mortality, and healthcare costs. Aim of the study This study aimed to identify the predictors of POAF following open cardiac surgery, with emphasis on biochemical parameters. Methods A total of 1191 patients with no preoperative atrial fibrillation (AF) and undergoing open cardiac surgery for any reason were included in this retrospective study. Data on clinical and biochemical parameters, the occurrence of new-onset AF, and its clinical course were retrieved from the hospital database. Results During the early postoperative period 330 patients (27.7%) developed atrial fibrillation, at median third postoperative day (range 1–6 days) and 217 (65.8%) responded to treatment. Multivariate analysis identified the following as the significant independent predictors of any POAF: EF < 60% (Odds ratio (OR), 2.6), valvular intervention (OR, 2.4), liver failure (OR, 2.4), diabetes (OR, 1.6), low hematocrit (OR, 2.1), low thrombocyte (OR, 5.6), low LDL (OR, 1.6), high direct bilirubin (OR, 2.0), low GFR (OR, 1.6), and high CRP (OR, 2.0). Following parameters emerged as significant independent predictors of persistent AF: EF < 60% (OR, 1.9), diabetes (OR, 2.1), COPD (OR, 1.8), previous cardiac surgery (OR, 3.1), valvular intervention (OR, 2.4), low hematocrit (OR, 1.9), low LDL (OR, 2.1), high HbA1c (OR, 2.0), and high CRP (OR, 2.7). Conclusions Certain parameters assessed during preoperative physical and laboratory examinations have the potential to be used as markers of POAF.
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Affiliation(s)
- Sevket T Turkkolu
- Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih/İstanbul, 34093, Istanbul, Turkey.
| | - Emre Selçuk
- Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih/İstanbul, 34093, Istanbul, Turkey
| | - Cengiz Köksal
- Department of Cardiovascular Surgery, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı, Vatan Caddesi, Fatih/İstanbul, 34093, Istanbul, Turkey
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Kertai MD, Mosley JD, He J, Ramakrishnan A, Abdelmalak MJ, Hong Y, Shoemaker MB, Roden DM, Bastarache L. Predictive Accuracy of a Polygenic Risk Score for Postoperative Atrial Fibrillation After Cardiac Surgery. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2021; 14:e003269. [PMID: 33647223 DOI: 10.1161/circgen.120.003269] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Postoperative atrial fibrillation (PoAF) remains a significant risk factor for increased morbidity and mortality after cardiac surgery. The ability to accurately identify patients at risk through clinical risk factors is limited. There is growing evidence that polygenic risk contributes significantly to PoAF and incorporating measures of genetic risk could enhance prediction. METHODS A retrospective cohort study of 1047 patients of White European ancestry who underwent either coronary artery bypass grafting or valve surgery at a tertiary academic center and were free from a history or persistent preoperative atrial fibrillation. The primary outcome was defined as PoAF based on postoperative ECG reports, medical record documentation, and changes in medication. The exposure was a polygenic risk score (PRS) comprising 2746 single-nucleotide polymorphisms previously associated with atrial fibrillation risk. The prediction of PoAF risk was assessed using measures of model discrimination, calibration, and net reclassification improvement. RESULTS A total of 259 patients (24.7%) developed PoAF. The PRS was significantly associated with a higher risk for PoAF (odds ratio, 1.63 per SD increase in PRS [95% CI, 1.41-1.90]). Addition of PRS to patient- and procedure-related predictors of PoAF significantly increased the C statistic from 0.742 to 0.782 (change in C statistic, 0.040 [95% CI, 0.021-0.060]) while maintaining good calibration. The addition of the PRS to patient- and procedure-related predictors of PoAF improved model fit (likelihood ratio test, P=2.8×10-15) and significantly improved measures of reclassification (net reclassification improvement, 0.158 [95% CI, 0.066-0.274]). CONCLUSIONS The PRS for PoAF was associated with improved discrimination, calibration, and risk reclassification compared with conventional clinical predictors suggesting that a PoAF PRS may enhance risk prediction of PoAF in patients undergoing coronary artery bypass grafting or valve surgery.
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Affiliation(s)
- Miklos D Kertai
- Departments of Anesthesiology (M.D.K.), Vanderbilt University Medical Center, Nashville, TN
| | - Jonathan D Mosley
- Medicine (J.D.M., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Jing He
- Biomedical Informatics (J.H., L.B., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Yurim Hong
- Vanderbilt University, Nashville, TN (A.R., M.A., Y.H.)
| | - M Benjamin Shoemaker
- Division of Cardiovascular Medicine, Nashville VA Medical Center and Vanderbilt University, TN (M.B.S.)
| | - Dan M Roden
- Medicine (J.D.M., D.M.R.), Vanderbilt University Medical Center, Nashville, TN.,Biomedical Informatics (J.H., L.B., D.M.R.), Vanderbilt University Medical Center, Nashville, TN.,Pharmacology (D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Lisa Bastarache
- Biomedical Informatics (J.H., L.B., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
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Bianco V, Kilic A, Mulukutla S, Gleason TG, Kliner D, Allen CC, Habertheuer A, Aranda-Michel E, Humar R, Navid F, Wang Y, Sultan I. Percutaneous coronary intervention versus coronary artery bypass grafting in patients with reduced ejection fraction. J Thorac Cardiovasc Surg 2021; 161:1022-1031.e5. [DOI: 10.1016/j.jtcvs.2020.06.159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 06/18/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
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50
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Darweesh RM, Baghdady YK, El Hossary H, Khaled M. Importance of left atrial mechanical function as a predictor of atrial fibrillation risk following cardiac surgery. Int J Cardiovasc Imaging 2021; 37:1863-1872. [PMID: 33591474 DOI: 10.1007/s10554-021-02163-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
Postoperative atrial fibrillation (POAF) after cardiac surgery is a major health problem that is associated with a significant financial burden and increased early morbidity and mortality. We investigated the accuracy of new echocardiographic derived indices to predict patients at higher risk of developing POAF. 84 consecutive patients (age 57.9 ± 6.9, 32% female) hospitalized for isolated CABG underwent comprehensive echocardiographic evaluation before surgery. Left atrial (LA) function was quantified through the assessment of phasic LA volumes to calculate LATEF. Speckle tracking echocardiography STE was used to measure LA reservoir strain, conduit strain and booster strain. Patients who developed POAF had increased LA volumes and impaired LA functions assessed by both the volumetric phasic changes and STE. By univariable analysis, all LA function parameters significantly predicted POAF. Multivariate regression analysis showed that age (P = 0.03, OR 1.134, 95% CI 1.012-1.271) and LATEF (P = 0.001, OR 0.814, 95% CI 0.725-0.914) were strong independent factors for POAF with LATEF showing the highest predictive accuracy. After multivariable adjustment to include LA strain indices to the base model, LA contractile strain LACtS (23.93 ± 4.19 vs 37.0 ± 3.35, p < 0.001) was the best discriminated for the highest predictive accuracy (OR 0.429, 95% CI 0.26-0.708). The ROC Curve was calculated for the greatest performance for prediction of POAF (AUC LACtS: 0.992; LATEF: 0.899). Adding new left atrial mechanics parameters is a more sensitive, independent tool that provides an incremental predictive value to discriminate patients at more risk for POAF.
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