1
|
Xie B, Song W, Yan Y, Korantzopoulos P, Tse G, Fu H, Qiao S, Han Y, Yuan M, Shao Q, Li G, Chen T, Liu T. Postoperative QRS duration to left ventricular end-diastolic diameter ratio as a predictor for the risk of postoperative atrial fibrillation in cardiac surgery: A single-center prospective study. Heliyon 2024; 10:e33785. [PMID: 39044992 PMCID: PMC11263650 DOI: 10.1016/j.heliyon.2024.e33785] [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: 08/15/2023] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/25/2024] Open
Abstract
Background and aims Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery and is associated with adverse clinical outcomes. Our study aimed at determining the clinical and echocardiographic predictors of POAF in patients with cardiac surgery and management of this group of patients may improve their outcome. Methods We prospectively enrolled patients from the department of cardiovascular surgery in the Second Hospital of Tianjin Medical University from October 23, 2020 to October 30, 2022, without a history of atrial fibrillation. Cox regression was used to identify significant predictors of POAF. Results A total of 217 patients (79 [36.41 %] were female, 63.96 ± 12.32 years) were included. 88 (40.55 %) patients met the criteria for POAF. Cox regression showed that preoperative left atrial diameter (LAD) (HR: 1.040, 95 % CI 1.008-1.073, p = 0.013) and postoperative QRS/LVEDD (HR: 0.398, 95 % CI 0.193-0.824, p = 0.013) and E/e' (HR: 1.029, 95 % CI 1.002-1.057,p = 0.033) were predictors of POAF. Conclusion Preoperative LAD and postoperative QRS/LVEDD and E/e' were predictors of POAF in patients undergoing cardiac surgery. Trial registration site http://www.chictr.org.cn. Registration number ChiCTR2200063344.
Collapse
Affiliation(s)
- Bingxin Xie
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Wenhua Song
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yingqun Yan
- Department of Cardiovascular Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Panagiotis Korantzopoulos
- First Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
| | - Huaying Fu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Shuai Qiao
- Department of Cardiovascular Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yongyong Han
- Department of Cardiovascular Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Meng Yuan
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Qingmiao Shao
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Tienan Chen
- Department of Cardiovascular Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| |
Collapse
|
2
|
Mekonen Gdey M, Buch P, Pareesa F, Thorani M, Nasser H, Bandaru RR, Wei CR, Palleti SK. Predictors of Developing Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e51316. [PMID: 38288215 PMCID: PMC10823463 DOI: 10.7759/cureus.51316] [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] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
The objective of this study was to determine predictors of postoperative atrial fibrillation (POAF) among coronary artery bypass graft (CABG) patients. This meta-analysis was conducted as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Two authors performed searches independently using electronic databases, including Embase, PubMed, and Web of Science, from January 1, 2015, to November 30, 2023. A total of 16 studies were included in this meta-analysis. All included studies reported POAF in patients undergoing CABG, resulting in 1462 cases of POAF among 6200 patients undergoing CABG. The cases of POAF varied among studies, ranging from 7.80% to 47.37%. The pooled incidence of POAF was 26% (95% CI: 20% to 31%). The results indicated that older patients had a higher risk of developing atrial fibrillation (AF) after CABG (mean difference [MD]): 5.63, 95% confidence interval (CI): 4.08 to 7.17, p-value < 0.001). The findings revealed a significantly lower left ventricular ejection fraction (LVEF) in patients developing AF than their counterparts (MD: -0.30, 95% CI: -0.58 to -0.03, p-value: 0.03). Regarding the history of myocardial infarction (MI), the odds of MI were significantly higher in patients developing AF compared to those who did not develop AF (odds ratio [OR]: 1.37, 95% CI: 1.12 to 1.68, p-value: 0.002). In relation to intra-aortic balloon pump (IABP), the odds of IABP were significantly higher in patients developing AF compared to those who did not develop AF (OR: 2.27, 95% CI: 1.39 to 3.72, p-value: 0.001). Identified risk factors for post-CABG AF included advanced age, a lower preoperative ejection fraction, a history of myocardial infarction, the requirement for an IABP, and prolonged cardiopulmonary bypass (CPB) time. The study underscores the significance of proactive screening and comprehensive management for elderly CABG patients, particularly those with myocardial infarction histories.
Collapse
Affiliation(s)
| | - Purvi Buch
- Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gotri, IND
| | - Fnu Pareesa
- Medicine, People's University of Medical and Health Sciences Nawabshah, Karachi, PAK
| | - Mahek Thorani
- Internal Medicine, People's University of Medical and Health Sciences Nawabshah, Karachi, PAK
| | - Hazem Nasser
- Medicine, John H. Stroger, Jr. Hospital of Cook County, Illinois, USA
| | | | - Calvin R Wei
- Research and Development, Shing Huei Group, Taipei, TWN
| | - Sujith K Palleti
- Nephrology, Louisiana State University Health Sciences Center, Shreveport, USA
| |
Collapse
|
3
|
Fu M, Zhang Y, Zhao Y, Guo J, Hou Z, Zhang Y, Wang Z. Characteristics of preoperative atrial fibrillation in geriatric patients with hip fracture and construction of a clinical prediction model: a retrospective cohort study. BMC Geriatr 2023; 23:310. [PMID: 37202743 DOI: 10.1186/s12877-023-03936-9] [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: 12/01/2022] [Accepted: 03/27/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Atrial fibrillation is the most common atrial arrhythmia in the perioperative period and is associated with prolonged hospital stay, increased costs, and increased mortality. However, there are few data on the predictors and incidence of preoperative atrial fibrillation in hip fracture patients. Our aim was to identify predictors of preoperative atrial fibrillation and to propose a valid clinical prediction model. METHODS Predictor variables included demographic and clinical variables. LASSO regression analyzes were performed to identify predictors of preoperative atrial fibrillation, and models were constructed and presented as nomograms. Area under the curve, calibration curve, and decision curve analysis (DCA) were used to examine the discriminative power, calibration, and clinical efficacy of the predictive models. Bootstrapping was used for validation. RESULTS A total of 1415 elderly patients with hip fractures were analyzed. Overall, 7.1% of patients had preoperative atrial fibrillation, and they were at significant risk for thromboembolic events. Patients with preoperative AF had a significantly longer delay in surgery than those without preoperative atrial fibrillation (p < 0.05). Predictors for preoperative atrial fibrillation were hypertension (OR 1.784, 95% CI 1.136-2.802, p < 0.05), C-reactive protein at admission (OR 1.329, 95% CI 1.048-1.662, p < 0.05), systemic inflammatory response index at admission (OR 2.137, 95% CI, 1.678-2.721 p < 0.05), Age-Adjusted Charlson Comorbidity Index (OR 1.542, 95% CI 1.326-1.794, p < 0.05), low potassium(OR 2.538, 95% CI 1.623-3.968, p < 0.05), anemia(OR 1.542, 95% CI 1.326-1.794, p < 0.05). Good discrimination and calibration effect of the model was showed. Interval validation could still achieve the C-index value of 0.799. DCA demonstrated this nomogram has good clinical utility. CONCLUSION This model has a good predictive effect on preoperative atrial fibrillation in elderly patients with hip fractures, which can help to better plan clinical evaluation.
Collapse
Affiliation(s)
- Mingming Fu
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yaqian Zhang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yuqi Zhao
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Junfei Guo
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (Third Hospital of Hebei Medical University), Hebei, China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, People's Republic of China.
- NHC Key Laboratory of Intelligent Orthopeadic Equipment (Third Hospital of Hebei Medical University), Hebei, China.
- Chinese Academy of Engineering, Beijing, 100088, People's Republic of China.
| | - Zhiqian Wang
- Department of Geriatric Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
| |
Collapse
|