Objective
The present study aimed to validate the utility of bedside cardiac ultrasound to identify
patients for the risk of postoperative atrial fibrillation (POAF).
Design
A prospective cohort study of consecutive patients.
Setting
Single-center tertiary referral center.
Participants
After Institutional Review Board consent, 169 patients undergoing elective cardiac
surgery were enrolled in the study.
Interventions
A preoperative transthoracic echocardiographic interrogation assessing diastolic function
was performed. Measurements were assessed offline with experienced echocardiographers
blinded to clinical outcomes.
Measurements and Main Results
The primary outcome was POAF during the first 72 hours after surgery. A total of 169
patients completed the study, 44 of whom (26.0%) developed POAF, and 39 (25.2%) had
diastolic dysfunction. Patients with POAF had a higher rate of postoperative heart
failure, reintubation within 24 hours of surgery, and length of stay (p = 0.002, 0.01,
and 0.0006, respectively). Predictors significant for POAF included increasing age,
left atrial volume indexed to body surface area (LAVI), and diastolic dysfunction
(p = 0.02, 0.0001, and 0.001, respectively). Multivariate spline regressions demonstrated
a nonlinear correlation between increasing LAVI and risk of POAF.
Conclusion
Left atrial volume can be assessed efficiently preoperatively to provide superior
risk stratification over clinical factors and diastolic parameters alone for the prediction
of POAF. Furthermore, the present study demonstrated that the cutoffs of chamber quantification
currently used do not appropriately capture the increased risk of POAF. Thus, LAVI
provides a simple measure to identify patients who are in need of targeted prophylaxis
for POAF.
Key Words
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Article Info
Publication History
Published online: October 18, 2019
Identification
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© 2019 Elsevier Inc. All rights reserved.
