Turk Kardiyol Dern Ars. 2016; 44(1): 45-52 | DOI: 10.5543/tkda.2015.11354
Predictive role of left atrial and ventricular mechanical function in postoperative atrial fibrillation: a two-dimensional speckle-tracking echocardiography study
, Kursat Tigen2
, Gokhan Gozubuyuk4
, Cihan Dundar3
, Ahmet Guler5
, Onur Taşar6
, Murat Biteker1
, Can Yücel Karabay5
, Mustafa Bulut5
, Tansu Karaahmet7
, Cevat Kırma51
Mugla Sitki Kocman University, Faculty of Medicine, Department of Cardiology, Mugla, Turkey2
Marmara University, Faculty Of Medicine, Department Of Cardiology, Istanbul, Turkey3
Buyuk Meydan Hospital, Cardiology Clinic, Samsun, Turkey4
Malatya State Hospital, Cardiology Clinic, Malatya, Turkey5
Kartal Kosuyolu Heart Education And Research Hospital, Cardiology Clinic, Istanbul, Turkey6
Elazığ Education And Research Hospital, Cardiology Clinic, Elazıg, Turkey7
Acıbadem University, Faculty Of Medicine, Department Of Cardiology, Istanbul, Turkey
OBJECTIVE The aim of this study was to determine the role of leftsided mechanical parameters in postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).
METHODS Ninety patients with coronary artery disease and normal left ventricular (LV) function in sinus rhythm were enrolled in the study. Preoperative LV and left atrial (LA) mechanics were evaluated by two-dimensional (2D) speckle-tracking echocardiography (STE), including strain and rotation parameters, and volume indices. Patients were monitored in order to detect POAF during the postoperative period.
RESULTS Twenty-three of 90 patients (25.6%) developed POAF. Age (p<0.001) and preoperative beta blocker usage (p=0.001) were the clinical parameters associated with POAF. Left atrial maximum volume index (LAV[max]i) increased, and peak left atrial longitudinal strain (PALS) was impaired in POAF patients (p=0.001, p<0.001, respectively). Left ventricular twist (LVtw) and left ventricular peak untwisting velocity (UntwV) were augmented in POAF patients (p=0.013, p=0.009, respectively). Receiver operating characteristic analysis showed N-terminal pro-brain natriuretic peptide (NT-proBNP) levels above 70 pg/ml and predicted POAF with a sensitivity of 74% and specificity of 78% (area under curve: 0.758, 95% confidence interval [CI] 0.6310.894, p<0.001). Logistic regression analysis demonstrated that age (odds ratio [OR] 1.1, CI 1.011.20, p=0.034), preoperative beta blocker usage (OR 8.84, CI 1.3657.28, p=0.022), NT-proBNP (values >70 pg/ml, OR 22.377, CI 3.286152.381, p<0.001), PALS (OR 0.86, CI 0.750.98, p=0.023), and UntwV (OR 1.02, CI 1.001.04, p=0.029) were the independent predictors of POAF.
CONCLUSION The combination of 2D STE, clinical, and biochemical parameters may help predict POAF.
Atrial fibrillation, coronary artery disease; left atrial strain; left ventricular strain; speckle tracking echocardiography.
Özcan Başaran, Kursat Tigen, Gokhan Gozubuyuk, Cihan Dundar, Ahmet Guler, Onur Taşar, Murat Biteker, Can Yücel Karabay, Mustafa Bulut, Tansu Karaahmet, Cevat Kırma. Predictive role of left atrial and ventricular mechanical function in postoperative atrial fibrillation: a two-dimensional speckle-tracking echocardiography study. Turk Kardiyol Dern Ars. 2016; 44(1): 45-52
Corresponding Author: Özcan Başaran, Türkiye