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Predictive value of preoperative echocardiographic assessment for postoperative atrial fibrillation after esophagectomy for esophageal cancer

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Abstract

Background

Postoperative atrial fibrillation (POAF) after esophagectomy for esophageal cancer is not uncommon. The aim of this study is to examine whether preoperative transthoracic echocardiography is useful for predicting new-onset POAF in esophageal cancer.

Methods

In this prospective observational study, we evaluated 200 patients with esophageal cancer who underwent esophagectomy at our hospital between January 2016 and July 2019. Conventional echocardiographic assessment and tissue Doppler imaging were performed before surgery. We investigated the utility of preoperative transthoracic echocardiography for predicting new-onset POAF in esophageal cancer.

Results

New-onset POAF occurred in 51 (25.5%) of 200 patients. POAF was significantly associated with older age (p = 0.007), higher body mass index (p = 0.020), preoperative hypertensive disease (p = 0.021), and lower hemoglobin level (p = 0.028). The incidence of postoperative complications was significantly higher in patients with POAF than in patients without POAF (43.1% vs. 24.2%, p = 0.013). Transthoracic echocardiography showed that left atrial diameter (LAD) and E wave/e′ wave ratio (E/e′) were significantly higher in patients with POAF than in patients without POAF (34.1 vs. 31.3 mm, p < 0.001 and 11.6 vs. 10.5, p = 0.003, respectively). Multivariate analysis showed that LAD ≥ 36.0 mm, E/e′ ≥ 8.4 are independent risk factors for POAF (odds ratios 2.47 and 3.64; p values 0.035 and 0.027, respectively)

Conclusions

Preoperative echocardiographic evaluation is useful for predicting the onset of POAF after esophagectomy for esophageal cancer. Risk stratification using LAD and E/e′ enables clinicians to identify patients at high risk for POAF before esophagectomy.

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Abbreviations

POAF:

Postoperative atrial fibrillation

LAD:

Left atrial diameter

DcT:

Deceleration time

AF:

Atrial fibrillation

ICU:

Intensive care unit

POD:

Postoperative day

ECG:

Electrocardiography

LA:

Left atrial

LV:

Left ventricular

ROC:

Receiver operating characteristics

AUC:

Area under the curve

TDI:

Tissue Doppler imaging

LAVI:

Left atrial volume index

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Acknowledgements

The authors thank all the echocardiologists who contributed to this study, and IE, EK, YH, YY, NH, and YK for calculating echocardiographic parameters.

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Authors and Affiliations

  1. Department of Digestive Surgery, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka, 541-8567, Japan

    Yuta Nagatsuka, Keijiro Sugimura, Hiroshi Miyata, Naoki Shinnno, Kei Asukai, Hisashi Hara, Shinichiro Hasegawa, Daisaku Yamada, Kazuyoshi Yamamoto, Naotsugu Haraguchi, Junichi Nishimura, Hiroshi Wada, Hidenori Takahashi, Masayoshi Yasui, Takeshi Omori, Masayuki Ohue & Masahiko Yano

  2. Department of Surgery, Osaka General Medical Center, 3-1-56, Manndaihigashi, Sumiyoshi-ku, Osaka, 541-8567, Japan

    Masaaki Motoori

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  1. Yuta Nagatsuka
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Corresponding author

Correspondence to Keijiro Sugimura.

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Ethical Statement

The Human Ethics Review Committee of the Osaka International Cancer Institute approved the study protocol.

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The authors have nothing to disclose.

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Subjects have provided written informed consent.

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Nagatsuka, Y., Sugimura, K., Miyata, H. et al. Predictive value of preoperative echocardiographic assessment for postoperative atrial fibrillation after esophagectomy for esophageal cancer. Esophagus 18, 496–503 (2021). https://doi.org/10.1007/s10388-020-00804-y

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  • DOI: https://doi.org/10.1007/s10388-020-00804-y

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