Skip to main content

Advertisement

SpringerLink
Log in

Importance of left atrial mechanical function as a predictor of atrial fibrillation risk following cardiac surgery

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

All data and materials are available and can be shared on reasonable request to the corresponding author.

Abbreviations

POAF:

Postoperative atrial fibrillation

LA:

Left atrium

BSA:

Body surface area

2DSTE:

2D speckle tracking echocardiography

LATEF:

Left atrial total ejection fraction

LAV:

Left atrial volume

LAVI:

Left atrial volume index

LAVmax :

Maximum left atrial volume

LAVmin :

Minimum left atrial volume

LAVmaxI:

Maximum left atrial volume index

LAVminI:

Minimum left atrial volume index

PALS:

Peak atrial longitudinal strain

LARSR:

Left atrial reservoir strain rate

LACtS:

Left atrial contractile strain

ACS:

Left atrial conduit strain

References

  1. Phan K, Ha HSK, Phan S, Medi C, Thomas SP, Yan TD (2015) New-onset atrial fibrillation following coronary bypass surgery predicts long term mortality: a systematic review and meta-analysis. Eur J Cardio-Thorac Surg 48:817–824

  2. Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63:493–505

    Article  Google Scholar 

  3. Ancona R, Pinto S, Caso P, D’Andrea A, Di Salvo G, Arenga F, Coppola MG, Sellitto V, Macrino M, Calabrò R (2014) Left atrium by echocardiography in clinical practice: from conventional methods to new echocardiographic techniques. Sci World J 2014:451042. https://doi.org/10.1155/2014/451042

    Article  Google Scholar 

  4. Shaikh A, Maan A, Khan U, Aurigemma G, Hill J, Kane J, Tighe DA, Mick E, McManus DD (2012) Speckle echocardiographic left atrial strain and stiffness index as predictors of maintenance of sinus rhythm after cardioversion for atrial fibrillation: a prospective study. Cardiovasc Ultrasound 10:48. https://doi.org/10.1186/1476-7120-10-48

    Article  PubMed  PubMed Central  Google Scholar 

  5. Yoon Y, Kim H, Kim S, Kim S, Park J, Park K, Choi S, Kim MK, Kim HS, Cho GY (2012) Left atrial mechanical function and stiffness in patients with paroxysmal atrial fibrillation. J Cardiovasc Ultrasound 20:140–145. https://doi.org/10.4250/jcu.2012.20.3.140

    Article  PubMed  PubMed Central  Google Scholar 

  6. Helgadottir S, Sigurdsso MI, Ingvarsdottir IL et al (2012) Atrial fibrillation following cardiac surgery: risk analysis and long-term survival. J Cardiothorac Surg 70–87

  7. Sasaki S, Watanabe T, Tamura H et al (2014) Left atrial strain as evaluated by two-dimensional speckle tracking predicts left atrial appendage dysfunction in patients with acute ischemic stroke. BBA Clin 2:40–47

    Article  Google Scholar 

  8. Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39

    Article  Google Scholar 

  9. Khoo CW, Krishnamoorthy S, Lim HS, Lip GY (2011) Assessment of left atrial volume: a focus on echocardiographic methods and clinical implications. Clin Res Cardiol 100:97–105

    Article  Google Scholar 

  10. Blume GG, Mcleod CJ, Barnes ME et al (2011) Left atrial function: physiology, assessment, and clinical implications. Eur J Echocardiogr 12:421–430

    Article  Google Scholar 

  11. Maiello M, Sharma RK, Matteo CM, Reddy HK, Palmiero P (2009) Differential left atrial remodelling in LV diastolic dysfunction and mitral regurgitation. Echocardiography 26:772–778

    Article  Google Scholar 

  12. Nagueh F, Smiseth O, Appleton C et al (2016) Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Am Soc Echocardiogr 29:277–314

    Article  Google Scholar 

  13. Zaman AG, Archbold RA, Helft G et al (2000) Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation 101(12):1403–1408

    Article  CAS  Google Scholar 

  14. Haghjoo M, Basiri H, Salek M et al (2008) Predictors of postoperative atrial fibrillation after coronary artery bypass graft surgery. Indian Pacing Electrophysiol J 8(2):94–101

    PubMed  PubMed Central  Google Scholar 

  15. Ferro CRC, de Oliveira DC, Nunes FP, Piegas LS (2009) Postoperative atrial fibrillation after cardiac surgery. Arq Bras Cardiol 93(1):59–63

    Article  Google Scholar 

  16. Pivatto Junior F, Teixeira Filho GF, Michelin St’anna JR et al (2014) Advanced age and incidence of atrial fibrillation in the postoperative period of aortic valve replacement. Rev Bras Cir Cardiovasc 29(1):45–50

    Article  Google Scholar 

  17. Kievišas M, Keturakis V, Vaitiekūnas E et al (2017) Prognostic factors of atrial fibrillation following coronary artery bypass graft surgery. Gen Thorac Cardiovasc Surg 65(10):566–574

    Article  Google Scholar 

  18. Villareal RP, Hariharan R, Liu BC et al (2004) Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 43:742–748

    Article  Google Scholar 

  19. Steinberg BA, Zhao Y, He X et al (2014) Management of postoperative atrial fibrillation and subsequent outcomes in contemporary patients undergoing cardiac surgery: insights from the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry. Clin Cardiol 37:7–13

    Article  Google Scholar 

  20. Mariscalco G, Biancari F, Zanobini M et al (2014) Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: the POAF score. J Am Heart Assoc 3(2):e000752

    Article  Google Scholar 

  21. Hernandez AV, Kaw R, Pasupuleti V et al (2013) Association between obesity and postoperative atrial fibrillation in patients undergoing cardiac operations: a systematic review and meta-analysis. Ann Thorac Surg 96:1104–1116

    Article  Google Scholar 

  22. Tayyareci Y, Yildirimturk O, Aytekin V et al (2010) Preoperative left atrial mechanical dysfunction predicts postoperative atrial fibrillation after coronary artery bypass graft operation. Circ J 74:2109–2117

    Article  Google Scholar 

  23. Echahidi N, Pibarot P, O’Hara G, Mathieu P (2008) Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 51:793–801

    Article  CAS  Google Scholar 

  24. Huxley R, Alonso A, Lopez F et al (2012) Type 2 diabetes, glucose homeostasis and incident atrial fibrillation: the Atherosclerosis Risk in Communities study. Heart 98:133–138

    Article  CAS  Google Scholar 

  25. Goudis CA, Korantzopoulos P, Ntalas IV et al (2015) Diabetes mellitus and atrial fibrillation: pathophysiological mechanisms and potential upstream therapies. Int J Cardiol 184:617–622

    Article  Google Scholar 

  26. Brinkman W, Herbert MA, O’Brien S et al (2014) Preoperative beta blocker use in coronary artery bypass grafting surgery: national database analysis. JAMA Intern Med 174:1320–1327

    Article  Google Scholar 

  27. Lancaster TS, Schill MR, Greenberg JW et al (2016) Potassium and magnesium supplementation do not protect against atrial fibrillation after cardiac operation: a time-matched analysis. Ann Thorac Surg 102:1181–1188

    Article  Google Scholar 

  28. Jaїs P, Peng JT, Shah DC et al (2000) Left ventricular diastolic dysfunction in patients with so-called lone atrial fibrillation. J Cardiovasc Electrophysiol 11:623–625

    Article  Google Scholar 

  29. Takagi T, Takagi A, Yoshikawa J (2014) Elevated left ventricular filling pressure estimated by E/E′ ratio after exercise predicts development of new-onset atrial fibrillation independently of left atrial enlargement among elderly patients without obvious myocardial ischemia. J Cardiol 63:128–133

    Article  Google Scholar 

  30. Rader F, Gajulapalli RD, Pasala T, Einstadter D (2012) Abnormal left ventricular filling and postoperative atrial fibrillation after cardiac surgery. J Atr Fibrillation 5(3):634. https://doi.org/10.4022/jafib.634

    Article  PubMed  PubMed Central  Google Scholar 

  31. Haffajee JA, Lee Y, Alsheikh-Ali AA et al (2011) Pre- operative left atrial mechanical function predicts risk of atrial fibrillation following cardiac surgery. JACC Cardiovasc Imaging 4:833–840

    Article  Google Scholar 

  32. Osranek M, Fatema K, Qaddoura F et al (2006) Left atrial volume predicts the risk of atrial fibrillation after cardiac surgery: a prospective study. J Am Coll Cardiol 48:779–786

    Article  Google Scholar 

  33. Pagola J, Gonzalez-Alujas T, Flores A, Muchada M, Rodriguez-Luna D, Sero L et al (2014) Left atria strain is a surrogate marker for detection of atrial fibrillation in cryptogenic strokes. Stroke 45(8):e164–e166

    Article  Google Scholar 

  34. Obokata M, Negishi K, Kurosawa K, Tateno R, Tange S, Arai M et al (2014) Left atrial strain provides incremental value for embolism risk stratification over CHA(2)DS(2)-VASc score and indicates prognostic impact in patients with atrial fibrillation. J Am Soc Echocardiogr 27(7):709–716

    Article  Google Scholar 

  35. Hsu PC, Lee WH, Chu CY, Lee HH, Lee CS, Yen HW et al (2016) Prognostic role of left atrial strain and its combination index with transmitral E-wave velocity in patients with atrial fibrillation. Sci Rep 6:17318

    Article  CAS  Google Scholar 

  36. Kim D, Shim CY, Cho IJ, Kim YD, Nam HS, Chang HJ et al (2016) Incremental value of left atrial global longitudinal strain for prediction of post stroke atrial fibrillation in patients with acute ischemic stroke. J Cardiovasc Ultrasound 24(1):20–27

    Article  Google Scholar 

  37. Leung M, van Rosendael PJ, Abou R, Ajmone Marsan N, Leung DY, Delgado V et al (2018) Left atrial function to identify patients with atrial fibrillation at high risk of stroke: new insights from a large registry. Eur Heart J 39(16):1416–1425

    Article  Google Scholar 

  38. Barbier P, Solomon SB, Schiller NB, Glantz SA (1999) Left atrial relaxation and left ventricular systolic function determine left atrial reservoir function. Circulation 100:427–436

    Article  CAS  Google Scholar 

  39. Li D, Fareh S, Leung TK, Nattel S (1999) Promotion of atrial fibrillation by heart failure in dogs: atrial remodelling of a different sort. Circulation 100:87–95

    Article  CAS  Google Scholar 

  40. Caselli S, Canali E, Foschi ML et al (2010) Long term prognostic significance of three dimensional echocardiographic parameters of the left ventricle and left atrium. Eur J Echocardiogr 11:150–156

    Article  Google Scholar 

Download references

Funding

None (there have been no significant financial support).

Author information

Authors and Affiliations

  1. Cairo University, Giza, Egypt

    Reham Mohamed Darweesh, Yasser Kamal Baghdady, Hossam El hossary & Mohamed Khaled

Authors
  1. Reham Mohamed Darweesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yasser Kamal Baghdady
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hossam El hossary
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohamed Khaled
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

YB shared in planning the research then guided and supervised the methodology, revised the manuscript. HE supervised the research methodology and shared in revising the manuscript. RM supervised the methodology, collected and analysed the data and was a major contributor in writing the manuscript. All authors of this paper have read and approved the final version submitted.

Corresponding author

Correspondence to Reham Mohamed Darweesh.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research is approved by local ethical committee of kasr el Aini medical school, faculty of medicine Cairo university (reference number is not available) and an informed written consent was taken from patients included in this study.

Consent for publication

We declare that this manuscript is original and has not been published before and not currently being considered for publication elsewhere.

Research involving human participants and/or animals

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Darweesh, R.M., Baghdady, Y.K., El hossary, H. et al. Importance of left atrial mechanical function as a predictor of atrial fibrillation risk following cardiac surgery. Int J Cardiovasc Imaging 37, 1863–1872 (2021). https://doi.org/10.1007/s10554-021-02163-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-021-02163-w

Keywords

Search

Navigation