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Zhang D, Zhang Z, Zhen Y, Liu X, Fan X, Ye Z, Liu P. New-onset postoperative atrial fibrillation after pulmonary endarterectomy is associated with adverse outcomes. Front Surg 2024; 11:1380570. [PMID: 38872724 PMCID: PMC11169783 DOI: 10.3389/fsurg.2024.1380570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/10/2024] [Indexed: 06/15/2024] Open
Abstract
Background New-onset postoperative atrial fibrillation (POAF) is a common complication after pulmonary thromboendarterectomy (PEA), yet the risk factors and their impact on prognosis remain poorly understood. This study aims to investigate the risk factors associated with new-onset POAF after PEA and elucidate its underlying connection with adverse postoperative outcomes. Methods A retrospective analysis included 129 consecutive chronic thromboembolic pulmonary hypertension (CTEPH) patients and 16 sarcoma patients undergoing PEA. Univariate and multivariate analyses were conducted to examine the potential effects of preoperative and intraoperative variables on new-onset POAF following PEA. Propensity score matching (PSM) was then employed to adjust for confounding factors. Results Binary logistic regression revealed that age (odds ratio [OR] = 1.041, 95% confidence interval [CI] = 1.008-1.075, p = 0.014) and left atrial diameter[LAD] (OR = 1.105, 95% CI = 1.025-1.191, p = 0.009) were independent risk factors for new-onset POAF after PEA. The receiver operating characteristic (ROC) curve indicated that the predictive abilities of age and LAD for new-onset POAF were 0.652 and 0.684, respectively. Patients with new-onset POAF, compared with those without, exhibited a higher incidence of adverse outcomes (in-hospital mortality, acute heart failure, acute kidney insufficiency, reperfusion pulmonary edema). Propensity score matching (PSM) analyses confirmed the results. Conclusion Advanced age and LAD independently contribute to the risk of new-onset POAF after PEA. Patients with new-onset POAF are more prone to adverse outcomes. Therefore, heightened vigilance and careful monitoring of POAF after PEA are warranted.
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Affiliation(s)
- Dingkai Zhang
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhaohua Zhang
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
- Department of Cardiovascular Surgery, Peking University China-Japan Friendship School of Clinical Medicine, Beijing, China
| | - Yanan Zhen
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaopeng Liu
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xueqiang Fan
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhidong Ye
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Peng Liu
- China-Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, China-Japan Friendship Hospital, Beijing, China
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2
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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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3
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Jiang S, Liao X, Chen Y, Li B. Exploring postoperative atrial fibrillation after non-cardiac surgery: mechanisms, risk factors, and prevention strategies. Front Cardiovasc Med 2023; 10:1273547. [PMID: 38130687 PMCID: PMC10733488 DOI: 10.3389/fcvm.2023.1273547] [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: 08/06/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Atrial fibrillation (AF) stands as the most prevalent persistent arrhythmia and a common complication after surgical procedures. Although the majority of non-cardiac surgery patients experience postoperative AF (POAF) and the condition is typically self-limited and asymptomatic, its detrimental impact on patient outcomes, prolonged hospitalization, and heightened risk of stroke and overall mortality has become increasingly evident. Of significant concern, POAF emerges as a noteworthy risk factor for stroke, myocardial infarction, and mortality in comparison to patients with non-surgical atrial fibrillation. Multiple studies have corroborated the association between POAF and an elevated risk of stroke and mortality. The development of postoperative atrial fibrillation is multifactorial, with the inflammatory response being a primary contributor; additionally, factors such as hypovolemia, intraoperative hypotension, anemia, trauma, and pain can trigger POAF. Risk factors for POAF in non-cardiac surgery primarily relate to age, hypertension, obesity, prior cardiac disease, obstructive sleep apnea, and male sex. Prophylactic treatment with β-blockers, amiodarone, or magnesium has demonstrated efficacy, but further trials are warranted, especially in high-risk populations. This review provides an account of the incidence rate, pathophysiology, and prognosis of atrial fibrillation after non-cardiac surgery, elucidates the underlying mechanisms of its occurrence, and explores various preventive strategies investigated in this domain.
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Affiliation(s)
- Shengjie Jiang
- Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
| | | | | | - Binfei Li
- Department of Anesthesiology, Zhongshan City People’s Hospital, Zhongshan, Guangdong, China
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4
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Tempe DK, Maheshwari A, Fatima N, Khurana P, Geelani MA, Minhas HS. Role of magnesium alone or in combination with diltiazem and/or amiodarone in prevention of atrial fibrillation following off-pump coronary artery bypass grafting. Ann Card Anaesth 2023; 26:399-404. [PMID: 37861573 PMCID: PMC10691575 DOI: 10.4103/aca.aca_35_23] [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] [Received: 03/11/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 10/21/2023] Open
Abstract
Objectives In this study the authors have tried to examine the role of magnesium alone or in combination with diltiazem and / or amiodarone in prevention of atrial fibrillation (AF) following off-pump coronary artery bypass grafting (CABG). Background AF after CABG is common and contributes to morbidity and mortality. Various pharmacological preventive measures including magnesium, amiodarone, diltiazem, and combination therapy among others have been tried to lower the incidence of AF. Most of the studies have been performed in patients undergoing conventional on-pump CABG. In this uncontrolled trial, efficacy of magnesium alone or in combination with amiodarone and / or diltiazem has been studied in patients undergoing off-pump CABG. Methods One hundred and fifty patients undergoing off-pump CABG were divided into 3 groups, Group M (n=21) received intraoperative magnesium infusion at 30mg/ kg over 1 hour after midline sternotomy; Group MD (n=78) received magnesium infusion in similar manner with diltiazem infusion at 0.05 μg/kg/hr throughout the intraoperative period; Group AMD (n=51) received preoperative oral amiodarone at a dose of 200 mg three times a day for 3 days followed by 200 mg twice daily for another 3 days followed by 200 mg once daily till the day of surgery along with magnesium and diltiazem infusion as in other groups. AF lasting more than 10 min or requiring medical intervention was considered as AF. Results The overall incidence of postoperative AF was 12.6% with 11.7% in group AMD, 19% in group M, and 11.5% in group MD, which was not statistically significant. Conclusions It is concluded that the use of amiodarone and/or diltiazem in addition to magnesium did not result in additional benefit of lowering the incidence of AF.
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Affiliation(s)
- Deepak K. Tempe
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Ankit Maheshwari
- Department of Cardiothoracic and Vascular Surgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Nirmeen Fatima
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Priyanka Khurana
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Muhammad A. Geelani
- Department of Cardiothoracic and Vascular Surgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Harpreet S. Minhas
- Department of Cardiothoracic and Vascular Surgery, GB Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Samaritaki E, Tsiligianni I, Basta M, Alegkakis A, Vlassiadis K, Lazopoulos G. Demographic and clinical predictors of post-operative atrial fibrillation in cardio-surgical patients. Eur J Cardiovasc Nurs 2023; 22:98-106. [PMID: 35672278 DOI: 10.1093/eurjcn/zvac024] [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: 06/10/2021] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 01/14/2023]
Abstract
AIMS Post-operative atrial fibrillation is defined as an episode of atrial fibrillation that occurs 1-5 days after a surgical procedure in patients without a previous history of atrial fibrillation. Multiple factors such as demographics, cardiac surgical, endogenous, or mental health may relate to post-operative atrial fibrillation.The aim of this study was to identify multivariable high-risk factors for post-operative atrial fibrillation and to propose a risk-assessment tool. METHODS AND RESULTS A cross-sectional observational study was conducted in a University Hospital of Greece. Predictor variables examined demographic and clinical variables, anxiety, depression, health-related quality of life, frailty, perioperative mortality (European System for Cardiac Operative Risk Evaluation II), and 10-year survival/mortality risk (Charlson Comorbidity Index score). The outcome variable was post-operative atrial fibrillation. Multivariable analysis was assessed to identify predictors of post-operative atrial fibrillation.Ninety-one patients were included in our sample. Post-operative atrial fibrillation was diagnosed in 44 (48.4%). Factors associated with post-operative atrial fibrillation are the following: age group of 66-75 years [OR 5.78, 95% confidence interval (CI) 1.37-24.34], Charlson Comorbidity Index score (OR 1.42, 95% CI 1.07-1.89), and hours of mechanical ventilation (OR 1.03, 95% CI 1.00-1.06). The Charlson Comorbidity Index score was identified as an independent predictor of post-operative atrial fibrillation (exp: 1.412, 95% CI: 1.017-1.961). CONCLUSION Patients with post-operative atrial fibrillation had a higher Charlson Comorbidity Index score. The Charlson Comorbidity Index was identified as an independent clinical predictor of post-operative atrial fibrillation. The risk-assessment tool proposed includes age, Charlson Comorbidity Index score, and hours of mechanical ventilation. Future studies are needed to establish such an assessment.
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Affiliation(s)
- Evangelia Samaritaki
- School of Medicine, Department of Surgery, University of Crete, Crete, Greece.,Cardiac Surgery Department, University Hospital of Heraklion, Crete, Greece
| | - Ioanna Tsiligianni
- School of Medicine, Department of Social Medicine, University of Crete, Crete, Greece
| | - Maria Basta
- School of Medicine, Department of Psychiatry, University of Crete, Crete, Greece.,Department of Psychiatry, University Hospital of Heraklion, Crete, Greece
| | - Athanasios Alegkakis
- School of Medicine, Department of Toxicology, University of Crete, Crete, Greece
| | - Konstantinos Vlassiadis
- School of Medicine, Laboratory of Health Planning, University of Crete, Crete, Greece.,Dental Clinic, University Hospital of Heraklion, Crete, Greece
| | - Georgios Lazopoulos
- School of Medicine, Department of Surgery, University of Crete, Crete, Greece.,Cardiac Surgery Department, University Hospital of Heraklion, Crete, Greece
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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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7
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The Spillover Effects of Quality Improvement Beyond Target Populations in Mechanical Ventilation. Crit Care Explor 2022; 4:e0802. [PMID: 36419635 PMCID: PMC9678568 DOI: 10.1097/cce.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED To assess the impact of a mechanical ventilation quality improvement program on patients who were excluded from the intervention. DESIGN Before-during-and-after implementation interrupted time series analysis to assess the effect of the intervention between coronary artery bypass grafting (CABG) surgery patients (included) and left-sided valve surgery patients (excluded). SETTING Academic medical center. PATIENTS Patients undergoing CABG and left-sided valve procedures were analyzed. INTERVENTIONS A postoperative mechanical ventilation quality improvement program was developed for patients undergoing CABG. MEASUREMENTS AND MAIN RESULTS Patients undergoing CABG had a median mechanical ventilation time of 11 hours during P0 ("before" phase) and 6.22 hours during P2 ("after" phase; p < 0.001). A spillover effect was observed because mechanical ventilation times also decreased from 10 hours during P0 to 6 hours during P2 among valve patients who were excluded from the protocol (p < 0.001). The interrupted time series analysis demonstrated a significant level of change for ventilation time from P0 to P2 for both CABG (p < 0.0001) and valve patients (p < 0.0001). There was no significant difference in the slope of change between the CABG and valve patient populations across time cohorts (P0 vs P1 [p = 0.8809]; P1 vs P2 [p = 0.3834]; P0 vs P2 [p = 0.7672]), which suggests that the rate of change in mechanical ventilation times was similar between included and excluded patients. CONCLUSIONS Decreased mechanical ventilation times for patients who were not included in a protocol suggests a spillover effect of quality improvement and demonstrates that quality improvement can have benefits beyond a target population.
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8
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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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9
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Liu M, Mei K, Xie L, Ma J, Yu P, Niu S, Xu Y, Zhao Y, Liu X. Dose-response relationship among body mass index, abdominal adiposity and atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of 35 cohorts. PeerJ 2021; 9:e11855. [PMID: 34327066 PMCID: PMC8308618 DOI: 10.7717/peerj.11855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 07/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Whether overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF. Methods The PubMed, Cochrane Library, and EMBASE databases were searched for revelant studies (randomized controlled trials (RCTs), cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF. Results Thirty-five publications involving 33,271 cases/141,442 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, 95% CI [1.21–1.61]; P < 0.001), but not being underweight (RR: 1.44, 95% CI [0.90–2.30]; P = 0.13) or being overweight (RR: 1.03, 95% CI [0.95–1.11]; P = 0.48) was associated with an increased risk of POAF. In the exposure-effect analysis (BMI) was 1.09 (95% CI [1.05–1.12]; P < 0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (Pnonlinearity = 0.44); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. Additionally, waist obesity or visceral adiposity index was associated with the risk of POAF. Conclusion Based on the current evidence, our findings showed that high body mass index or abdominal adiposity was independently associated with an increased risk of POAF, while underweight or overweight might not significantly increase the POAF risk.
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Affiliation(s)
- Menglu Liu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Kaibo Mei
- Anesthesiology Department,, the People's Hospital of Shanggrao, Shangrao, Jiangxi, China
| | - Lixia Xie
- Department of Respiratory and Critical Care Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianyong Ma
- Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, Oh, China
| | - Peng Yu
- Department of Endocrine, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Siquan Niu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Ya Xu
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Yujie Zhao
- Department of Cardiology, Seventh People's Hospital of Zhengzhou, Zhengzhou, Henan, China
| | - Xiao Liu
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Guangzhou, Guangdong, China.,Guangzhou Key Laboratory of Molecular Mechanism and Translation in Major Cardiovascular Disease, Guangzhou, China
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10
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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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11
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Higgs M, Sim J, Traynor V. Incidence and risk factors for new-onset atrial fibrillation following coronary artery bypass grafting: A systematic review and meta-analysis. Intensive Crit Care Nurs 2020; 60:102897. [PMID: 32601010 DOI: 10.1016/j.iccn.2020.102897] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/11/2020] [Accepted: 05/23/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To estimate the incidence of new-onset post-operative atrial fibrillation after isolated coronary artery bypass surgery and summarise the evidence on risk factors that predispose people to developing the complication. STUDY DESIGN/METHODS A systematic review was conducted to identify studies from the CINAHL, MEDLINE and Cochrane databases. A title and abstract review was conducted by one reviewer. Full text review and quality assessment processes were conducted by two reviewers. Incidence data was combined in meta-analysis using the 'metaprop' routine in Stata and risk factor data were synthesised in narrative and table format. RESULTS Ten studies, including 6173 participants, were included in the review. The estimated pooled incidence of post-operative atrial fibrillation was 25% (CI 0.19-0.30). In a secondary meta-analysis including studies that only included first time bypass surgery recipients the estimated pooled incidence was 26% (CI 0.14-0.41). Due to high levels of heterogeneity these results should be interpreted with caution. Risk factors with the strongest associations to post-operative atrial fibrillation were chronic obstructive pulmonary disease, decreased partial pressure of oxygen on air, congestive heart failure, right coronary artery disease, male gender, prolonged cross clamp time and port-operative inotropic exposure. CONCLUSION Further prospective studies are needed to strengthen the current evidence base.
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Affiliation(s)
- Megan Higgs
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.
| | - Jenny Sim
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Victoria Traynor
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
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Velioglu Y, Yuksel A. Predictors of Postoperative Atrial Fibrillation after Beating-Heart Coronary Artery Bypass Surgery: Is Cardiopulmonary Bypass a Risk Factor? ACTA CARDIOLOGICA SINICA 2019; 35:468-475. [PMID: 31571795 DOI: 10.6515/acs.201909_35(5).20190325a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background To determine the risk factors and postoperative outcomes of new-onset atrial fibrillation (AF) following beating-heart coronary artery bypass grafting (CABG) surgery. Methods A total of 458 patients who underwent beating-heart CABG without the use of aortic cross clamping and cardioplegic arrest between January 2011 and January 2015 were included in the study, and they were divided into two groups according to the development of new-onset AF as the AF group (n = 143) and non-AF group (n = 315). Both groups were compared in terms of preoperative clinical features and perioperative data, and the risk factors and postoperative outcomes of AF following beating-heart CABG were determined. Results The incidence of postoperative AF was 31.2%. Patients in the AF group were significantly older (68.08 ± 7.76 vs. 61.76 ± 9.83 years, p ≤ 0.001) and had significantly higher use of cardiopulmonary bypass during surgery (69.2% vs. 43.2%, p ≤ 0.001) than the patients in the non-AF group. The patients with AF also had statistically significantly longer lengths of intensive care unit and hospital stay than those without AF (43.79 ± 32.39 vs. 30.49 ± 33.31 hours, p ≤ 0.001, and 8.20 ± 4.37 vs. 5.77 ± 2.16 days, p ≤ 0.001, respectively). Conclusions Our study revealed that age and the use of cardiopulmonary bypass during surgery were independent predictors of AF following beating-heart CABG. In addition, postoperative AF was associated with prolonged intensive care unit and hospital stay. Further prospective randomized studies with larger patient series are required to support our research and attain more accurate data.
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Affiliation(s)
- Yusuf Velioglu
- Department of Cardiovascular Surgery, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
| | - Ahmet Yuksel
- Department of Cardiovascular Surgery, Abant Izzet Baysal University Faculty of Medicine, Bolu, Turkey
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Sato H, Hosojima M, Ishikawa T, Aoki K, Okamoto T, Saito A, Tsuchida M. Glucose Variability Based on Continuous Glucose Monitoring Assessment Is Associated with Postoperative Complications after Cardiovascular Surgery. Ann Thorac Cardiovasc Surg 2017; 23:239-247. [PMID: 28717057 DOI: 10.5761/atcs.oa.17-00045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications. METHODS In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started. CIII and subcutaneous injections were initiated when blood glucose level exceeded 150 mg/dL. CGM data were used to analyze perioperative glycemic variability and association with postoperative complications. RESULTS Target glucose levels (71-180 mg/dL) were achieved during 97.1 ± 5.5% and 86.4 ± 19.0% of the continuous insulin infusion and subcutaneous injection periods, respectively. Major postoperative complications were surgical site infections, found in 6.6% of total patients, and atrial fibrillation, found in 44% of patients with off-pump coronary artery bypass grafting. High glycemic variability during SQII was associated with increased risk for both complications. CONCLUSION Data analysis revealed that our glucose management protocol during CIII was adequate. However, the management protocol during SQII required improvement.
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Affiliation(s)
- Hiroki Sato
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Michihiro Hosojima
- Department of Clinical Nutrition Science, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Tomomi Ishikawa
- Division of Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Kenji Aoki
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Takeshi Okamoto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Akihiko Saito
- Department of Applied Molecular Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Niigata, Japan
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Feldman A, Moreira DAR, Gun C, Wang HTL, Hirata MH, de Freitas Germano J, Leite GGS, Farsky P. Analysis of Circulating miR-1, miR-23a, and miR-26a in Atrial Fibrillation Patients Undergoing Coronary Bypass Artery Grafting Surgery. Ann Hum Genet 2017; 81:99-105. [PMID: 28422282 DOI: 10.1111/ahg.12188] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 01/28/2017] [Accepted: 01/30/2017] [Indexed: 01/04/2023]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia after cardiac surgery. From a pathophysiological point of view, a myriad of factors such as trauma, atrial dilation, ischemia, mechanical myopericarditis, autonomic imbalance, loss of connexins, AF nest remodeling, inflammation, sutures, and dysfunction caused by postextracorporeal circulation can contribute to postoperative atrial fibrillation (POAF) resulting in a longer hospital stay and consequently higher cost. Recent studies showed that short fragments of RNA, called microRNA (miRNA), can contribute to the development of several cardiovascular diseases, including AF. The aim of this study was to evaluate the levels of circulating miRNAs (miR-1, -23a, and -26a) that can be involved in POAF. Patients submitted to coronary artery bypass graft surgery were grouped in POAF (24 patients) and without POAF (24 patients). Results showed older age, longer clamp-time, and more days in the intensive care unit as well as a longer total hospital stay in the POAF group. Preoperative levels of circulating miRNAs were similar. Analysis of miRNAs revealed significantly lower circulating levels of miRNA-23a (P = 0.02) and -26a (P = 0.01) in the POAF group during the postoperative period. Receiver operating characteristic (ROC) analysis showed the area under the ROC curve of miR-23a and miR-26a for predicting FA was 0.63 (95% confidence interval [CI]: 0.51-0.74; P = 0.02) and 0.66 (95% CI: 0.55-0.77; P = 0.01), respectively. Our data suggests that circulating miRNA-23a and -26a may be involved in the underlying biology of postoperative AF development.
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Affiliation(s)
- Andre Feldman
- Instituto Dante Pazzanese de Cardiologia Sao Paulo, São Paulo, BR
| | | | - Carlos Gun
- Instituto Dante Pazzanese de Cardiologia Sao Paulo, São Paulo, BR
| | - Hui-Tzu Lin Wang
- Instituto Dante Pazzanese de Cardiologia Sao Paulo, São Paulo, BR
| | | | | | | | - Pedro Farsky
- Instituto Dante Pazzanese de Cardiologia Sao Paulo, São Paulo, BR
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Severe Cardiac Autonomic Derangement and Altered Ventricular Repolarization Pave the Way to Postoperative Atrial Fibrillation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 10:398-405. [PMID: 26680751 DOI: 10.1097/imi.0000000000000203] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Postoperative atrial fibrillation (POAF) is a frequent complication after heart surgery. It has been shown that cardiac autonomic derangement plays a significant role in the genesis of atrial fibrillation (AF) and that AF might also be promoted by altered repolarization. Thus, the aim of our study was to determine the levels of cardiac autonomic modulation and repolarization properties in patients developing POAF. METHODS Seventy-nine patients scheduled for aortic and/or coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled prospectively. High-resolution 20-minute electrocardiogram recordings were obtained day before surgery to determine P, PR, QT, and QTc intervals, as well as linear (time and frequency domain) and nonlinear heart rate variability parameters (fractal dimension and detrended fluctuation analysis). QTc interval was calculated using Framingham correction. RESULTS Twenty-nine patients developed POAF (AF group), and 50 did not (non-AF group). Groups were similar regarding demographics, surgery type, and perioperative characteristics, except for older age in the AF group. QT and QTc intervals (Framingham) were longer in the AF group [442 (44) vs 422 (28) milliseconds, P = 0.018; and 448 (44) vs 431 (24) milliseconds, P = 0.031 and P = 0.019, respectively]. Time domain heart rate variability parameter PNN50 (percentage of pairs of adjacent NN intervals differing >50 milliseconds) was higher [14% (21%) vs 8% (16%), P = 0.015], and nonlinear parameter detrended fluctuation analysis α2 was lower in the AF group [0.81 (0.21) vs 0.91 (0.20), P = 0.031]. CONCLUSIONS Profound cardiac autonomic derangement, suggestive of parasympathetic excessive modulation, exists preoperatively in patients inclined to POAF after cardiac surgery, whereby parameters PNN50 and α2 differentiated the AF from the non-AF group. Prolonged QTc intervals are associated with an increased risk of POAF.
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Postoperative Atrial Fibrillation after Coronary Artery Bypass Grafting Surgery: A Two-dimensional Speckle Tracking Echocardiography Study. Heart Lung Circ 2016; 25:993-9. [DOI: 10.1016/j.hlc.2016.02.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 12/06/2015] [Accepted: 02/02/2016] [Indexed: 11/18/2022]
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Perrier S, Meyer N, Hoang Minh T, Announe T, Bentz J, Billaud P, Mommerot A, Mazzucotelli JP, Kindo M. Predictors of Atrial Fibrillation After Coronary Artery Bypass Grafting: A Bayesian Analysis. Ann Thorac Surg 2016; 103:92-97. [PMID: 27577036 DOI: 10.1016/j.athoracsur.2016.05.115] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/16/2016] [Accepted: 05/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was conducted to identify preoperative predictors of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass grafting (CABG) by using a Bayesian analysis that included information from prior studies. METHODS We performed a prospective observational study from October 2008 to December 2013 of 1,481 patients who underwent isolated CABG with cardiopulmonary bypass and had no history of AF. Bayesian analysis was used to study the preoperative risks factors for POAF. RESULTS The POAF incidence was 21%. Multivariate analysis identified the following independent predictors of POAF after CABG: high CHA2DS2-VASc (Congestive heart failure, Hypertension [blood pressure >140/90 mm Hg or treated hypertension on medication], Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, vascular disease, Age 65 to 74 years, Sex category [female sex]) score (odds ratio [OR], 1.23; 95% credible interval [CI], 1.14 to 1.33 per 1-point increment, probability (Pr) [OR > 1] = 1), severe obesity with a body mass index of 35 kg/m2 or higher (OR, 1.28; 95% CI, 1.12 to 1.45; Pr [OR > 1] = 1), preoperative β-blocker use (OR, 1.12; 95% CI, 1.06 to 1.20; Pr [OR > 1] = 1), preoperative antiplatelet therapy (OR, 1.75; 95% CI, 1.14 to 2.79, Pr [OR > 1] = 1), and renal insufficiency with a creatinine clearance of less than 60 mL/min (OR, 1.34; 95% CI, 1.03 to 1.74; Pr [OR > 1] = 1). CONCLUSIONS This prospective Bayesian analysis identified five independent preoperative predictors of POAF after isolated CABG with cardiopulmonary bypass: CHA2DS2-VASc score, severe obesity, preoperative β-blocker use, preoperative antiplatelet therapy, and renal failure. The main interest in the CHA2DS2-VASc score as a predictor of POAF is that it is a simple and widely used bedside tool. Patients with these independent predictors of POAF may constitute a target population to test preventive strategies, such as non-antiarrhythmic and antiarrhythmic drugs.
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Affiliation(s)
- Stéphanie Perrier
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Nicolas Meyer
- Department of Public Health, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Tarek Announe
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Jonathan Bentz
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Philippe Billaud
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Arnaud Mommerot
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Jean-Philippe Mazzucotelli
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, Method and Clinical Research Group, University Hospital of Strasbourg, Strasbourg, France.
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Phan K, Khuong JN, Xu J, Kanagaratnam A, Yan TD. Obesity and postoperative atrial fibrillation in patients undergoing cardiac surgery: Systematic review and meta-analysis. Int J Cardiol 2016; 217:49-57. [PMID: 27179208 DOI: 10.1016/j.ijcard.2016.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 04/18/2016] [Accepted: 05/01/2016] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Post-operative atrial fibrillation (POAF) is one of the most common complications following cardiac surgery. However, it is unclear whether there is a relationship between obesity and POAF. We thus assessed all available evidence investigating the association between obesity and POAF, also considering any link between POAF and other post-operative conditions such as mortality, stroke, myocardial infarctions and respiratory complications. METHODS Five electronic databases were searched and relevant studies were identified. Data was extracted and meta-analyzed from the identified studies. RESULTS We found that obese patients had significantly higher odds of POAF when compared with non-obese patients (P=0.006). There was also significant heterogeneity among the identified studies. POAF when compared with no-POAF was associated with an increased risk of stroke (P<0.0001), 30-day mortality (P=0.005) and respiratory complications (P<0.00001). However, we found no significant link between POAF and myocardial infarctions (P=0.79). CONCLUSIONS Our findings suggest that obesity is associated with a moderately higher risk of POAF. While POAF is also associated with an increased incidence of stroke, 30-day mortality and respiratory complications, further studies must be conducted before conclusions can be made about the long-term outcomes.
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Affiliation(s)
- Kevin Phan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
| | | | - Joshua Xu
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Aran Kanagaratnam
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
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Premaratne S, Premaratne ID, Fernando ND, Williams L, Hasaniya NW. Atrial fibrillation and flutter following coronary artery bypass graft surgery: A retrospective study and review. JRSM Cardiovasc Dis 2016; 5:2048004016634149. [PMID: 27123238 PMCID: PMC4834471 DOI: 10.1177/2048004016634149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction and objectives Atrial fibrillation is a common arrhythmia following coronary artery bypass graft surgery. Its incidence can range from 10 to 60% of patients undergoing coronary artery bypass graft. This rhythm can result in shorter or longer intervals between beats. Methods Medical records of 143 patients from the Queen’s Medical Center, Kuakini Medical Center, Saint Francis Medical Center, and Straub Hospital and Clinic, all of which are located in Honolulu, Hawaii were reviewed. An additional 39 records of patients who did not develop these complications were also reviewed as a control group. Patients were selected according to the ICD codes for atrial fibrillation/flutter and coronary artery bypass graft. Both anomalies can lead to increased health care costs, morbidity, and mortality. In this study, possible predisposing factors to these complications were investigated. The time of onset, weight gain, elapsed time, fluid status (in/out), hematocrit, and drug regimens were compared between the two groups. Results The differences in weight gain, fluid status, and hematocrit between the groups were not significant. There were a total of 17 different drugs prescribed to the group as a whole but not every patient received the same regimen. Conclusions Atrial fibrillation and flutter were found to be more common in males, particularly between the ages of 60 and 69 years. There were no other significant findings.
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Affiliation(s)
- Shyamal Premaratne
- Hunter Holmes McGuire Veterans Administration Medical Center, USA; Virginia Union University, USA; Department of Surgery, John A. Burns School of Medicine, University of Hawaii, USA; Research Laboratory at the Queen's Medical Center, USA
| | | | | | | | - Nahidh W Hasaniya
- Department of Surgery, School of Medicine, Loma Linda University, USA; Department of Surgery, John A. Burns School of Medicine, University of Hawaii, USA; Research Laboratory at the Queen's Medical Center, USA
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Dong Z, Yu B, Zhang Q, Pei H, Xing J, Fang W, Sun Y, Song Z. Early Rehabilitation Therapy Is Beneficial for Patients With Prolonged Mechanical Ventilation After Coronary Artery Bypass Surgery. Int Heart J 2016; 57:241-6. [PMID: 26973269 DOI: 10.1536/ihj.15-316] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the effects of early rehabilitation therapy on prolonged mechanically ventilated patients after coronary artery bypass surgery (CABG).A total of 106 patients who underwent CABG between June 2012 and May 2015 were enrolled and randomly assigned into an early rehabilitation group (53 cases) and a control group (53 cases). The rehabilitation therapy consisted of 6 steps including head up, transferring from supination to sitting, sitting on the edge of bed, sitting in a chair, transferring from sitting to standing, and walking along a bed. The patients received rehabilitation therapy in the intensive care unit (ICU) after CABG in the early rehabilitation group. The control group patients received rehabilitation therapy after leaving the ICU.The results showed that the early rehabilitation therapy could significantly decrease the duration of mechanical ventilation (early rehabilitation group: 8.1 ± 3.3 days; control group: 13.9 ± 4.1 days, P < 0.01), hospital stay (early rehabilitation group: 22.0 ± 3.8 days; control group: 29.1 ± 4.6 days, P < 0.01), and ICU stay (early rehabilitation group: 11.7 ± 3.2 days; control group: 18.3 ± 4.2 days, P < 0.01) for patients requiring more than 72 hours prolonged mechanical ventilation. The results of Kaplan-Meier analysis showed that the proportions of patients remaining on mechanical ventilation in the early rehabilitation group were larger than that in the control group after 7 days of rehabilitation therapy (logrank test: P < 0.01). The results provide evidence for supporting the application of early rehabilitation therapy in patients requiring prolonged mechanical ventilation after CABG.
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Affiliation(s)
- Zehua Dong
- ICU, The Affiliated Hospital of Qingdao University
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21
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Kališnik JM, Hrovat E, Hrastovec A, Avbelj V, Žibert J, Geršak B. Severe Cardiac Autonomic Derangement and Altered Ventricular Repolarization Pave the Way to Postoperative Atrial Fibrillation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Jurij Matija Kališnik
- Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia
- Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nuernberg, Paracelsus Medical University, Nuremberg, Germany
| | - Eva Hrovat
- Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia
| | - Alenka Hrastovec
- Department of Anesthesiology and Intensive Care, University Medical Center, Ljubljana, Slovenia
| | - Viktor Avbelj
- Department of Communications and Computer Networks, Jožef Stefan Institute, Ljubljana, Slovenia
| | - Janez Žibert
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
| | - Borut Geršak
- Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia
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Mendes RG, de Souza CR, Machado MN, Correa PR, Di Thommazo-Luporini L, Arena R, Myers J, Pizzolato EB, Borghi-Silva A. Predicting reintubation, prolonged mechanical ventilation and death in post-coronary artery bypass graft surgery: a comparison between artificial neural networks and logistic regression models. Arch Med Sci 2015; 11:756-63. [PMID: 26322087 PMCID: PMC4548023 DOI: 10.5114/aoms.2015.48145] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 08/29/2013] [Accepted: 10/07/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In coronary artery bypass (CABG) surgery, the common complications are the need for reintubation, prolonged mechanical ventilation (PMV) and death. Thus, a reliable model for the prognostic evaluation of those particular outcomes is a worthwhile pursuit. The existence of such a system would lead to better resource planning, cost reductions and an increased ability to guide preventive strategies. The aim of this study was to compare different methods - logistic regression (LR) and artificial neural networks (ANNs) - in accomplishing this goal. MATERIAL AND METHODS Subjects undergoing CABG (n = 1315) were divided into training (n = 1053) and validation (n = 262) groups. The set of independent variables consisted of age, gender, weight, height, body mass index, diabetes, creatinine level, cardiopulmonary bypass, presence of preserved ventricular function, moderate and severe ventricular dysfunction and total number of grafts. The PMV was also an input for the prediction of death. The ability of ANN to discriminate outcomes was assessed using receiver-operating characteristic (ROC) analysis and the results were compared using a multivariate LR. RESULTS The ROC curve areas for LR and ANN models, respectively, were: for reintubation 0.62 (CI: 0.50-0.75) and 0.65 (CI: 0.53-0.77); for PMV 0.67 (CI: 0.57-0.78) and 0.72 (CI: 0.64-0.81); and for death 0.86 (CI: 0.79-0.93) and 0.85 (CI: 0.80-0.91). No differences were observed between models. CONCLUSIONS The ANN has similar discriminating power in predicting reintubation, PMV and death outcomes. Thus, both models may be applicable as a predictor for these outcomes in subjects undergoing CABG.
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Affiliation(s)
- Renata G Mendes
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - César R de Souza
- Computer Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Maurício N Machado
- Hospital de Base of São José do Rio Preto, Faculty of Medicine, São José do Rio Preto, SP, Brazil
| | - Paulo R Correa
- Hospital de Base of São José do Rio Preto, Faculty of Medicine, São José do Rio Preto, SP, Brazil
| | | | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois, Chicago, USA
| | - Jonathan Myers
- Cardiology Division, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA, USA
| | - Ednaldo B Pizzolato
- Computer Department, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
| | - Audrey Borghi-Silva
- Department of Physical Therapy, Federal University of Sao Carlos, Sao Carlos, SP, Brazil
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Yin L, Ling X, Zhang Y, Shen H, Min J, Xi W, Wang J, Wang Z. CHADS2 and CHA2DS2-VASc scoring systems for predicting atrial fibrillation following cardiac valve surgery. PLoS One 2015; 10:e0123858. [PMID: 25849563 PMCID: PMC4388656 DOI: 10.1371/journal.pone.0123858] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 03/09/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Clinical use of CHADS2 and CHA2DS2-VASc scoring systems for predicting AF following cardiac surgery have been reported in previous studies and demonstrated well-validated predictive value. We sought to investigate whether the two scoring systems are effective for predicting new-onset of AF following cardiac valve surgery and to demonstrate its potential utility of clinical assessment. Methods Medical records of all patients underwent cardiac valve surgeries during the period of January 2003 and December 2013 without preoperative AF at the cardiac center of our university were reviewed. The main outcome end point of our study was the early new-onset of AF following cardiac valve surgery. Results There were overall 518 patients involved in this study, with 234 (45.17%) developed POAF following valve surgery. Patients with POAF had older age (P=0.23) and higher BMI (P=0.013) than those without POAF. History of heart failure (P=0.025), hypertension (P=0.021), previous stroke or TIA (P=0.032), coronary artery disease (P=0.001), carotid artery disease (P=0.024) and preoperative medication of statins (P=0.021) were significantly more recorded in POAF group. Patients with POAF also had higher LAD (P=0.013) and E/e’ ratio (P<0.001). The CHADS2 and CHA2DS2-VASc scores were significantly higher in patients with POAF (P=0.002; P<0.001), and under univariate and multivariate regression analysis the CHADS2 and CHA2DS2-VASc scores were significant predictors of POAF (P=0.001; P<0.001). Based on stratification of CHADS2 and CHA2DS2-VASc scores, the Kaplan-Meier analysis obtained a higher POAF rate on patients with higher stratification of CHADS2 and CHA2DS2-VASc scores (P<0.001; P<0.001). Conclusion In conclusion, CHADS2 and CHA2DS2-VASc scores were directly associated with the incidence of POAF following valve surgery and a higher score was strongly predictive of POAF.
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Affiliation(s)
- Liang Yin
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Xinyu Ling
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Yufeng Zhang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Hua Shen
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Jie Min
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Wang Xi
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Jing Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Zhinong Wang
- Department of Cardiothoracic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
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