Diastolic dysfunction in patients undergoing cardiac surgery: A pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation

Rowlens Melduni, Rakesh M. Suri, James B. Seward, Kent R Bailey, Naser M. Ammash, Jae Kuen Oh, Hartzell V Schaff, Bernard J. Gersh

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Abstract

Objectives: Our goal was to investigate whether left ventricular (LV) diastolic dysfunction was an important pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation (POAF). Background: Atrial fibrillation is a common complication after cardiac surgery. However, the precise mechanism underlying its development remains poorly understood. Pre-existing alterations of myocardial diastolic function may predispose patients to the development of POAF. Methods: Patients were residents of Olmsted County, Minnesota, who underwent complete LV diastolic function assessment before coronary artery bypass grafting and/or valve surgery between January 1, 2000, and December 31, 2005. All were in sinus rhythm and had no history of atrial fibrillation, a pacemaker, mitral stenosis, or congenital heart disease. POAF was defined as any episode of atrial fibrillation within 30 days after surgery. Results: POAF occurred in 135 of 351 patients (38.5%). Patients with POAF were older (mean age 72.5 ± 10.3 years vs. 63.1 ± 14.1 years; p < 0.001) and more likely to have abnormal diastolic function. The rate of POAF increased exponentially with diastolic function grade (DFG) severity (p < 0.001). By multivariate analysis, after adjusting for clinical and surgical risk factors, independent predictors of POAF were older age (odds ratio [OR]: 1.05; p < 0.001), higher body mass index (OR: 1.06; p = 0.03), and abnormal LV DFG (DFG 1, OR: 5.12 [p = 0.006]; DFG 2, OR: 9.87 [p < 0.001]; and DFG 3, OR: 28.52 [p < 0.001]). Conclusions: LV diastolic dysfunction is a powerful, independent predisposing substrate for the initiation of POAF. Evaluation may be useful during risk stratification of patients undergoing cardiac surgery.

Original languageEnglish (US)
Pages (from-to)953-961
Number of pages9
JournalJournal of the American College of Cardiology
Volume58
Issue number9
DOIs
StatePublished - Aug 23 2011

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Atrial Fibrillation
Thoracic Surgery
Odds Ratio
Left Ventricular Dysfunction
Left Ventricular Function
Mitral Valve Stenosis
Ambulatory Surgical Procedures
Coronary Artery Bypass
Heart Diseases
Body Mass Index
Multivariate Analysis

Keywords

  • atrial fibrillation
  • cardiac surgery
  • diastolic dysfunction
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{4b1971a50d034d0796a8189754cdb68f,
title = "Diastolic dysfunction in patients undergoing cardiac surgery: A pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation",
abstract = "Objectives: Our goal was to investigate whether left ventricular (LV) diastolic dysfunction was an important pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation (POAF). Background: Atrial fibrillation is a common complication after cardiac surgery. However, the precise mechanism underlying its development remains poorly understood. Pre-existing alterations of myocardial diastolic function may predispose patients to the development of POAF. Methods: Patients were residents of Olmsted County, Minnesota, who underwent complete LV diastolic function assessment before coronary artery bypass grafting and/or valve surgery between January 1, 2000, and December 31, 2005. All were in sinus rhythm and had no history of atrial fibrillation, a pacemaker, mitral stenosis, or congenital heart disease. POAF was defined as any episode of atrial fibrillation within 30 days after surgery. Results: POAF occurred in 135 of 351 patients (38.5{\%}). Patients with POAF were older (mean age 72.5 ± 10.3 years vs. 63.1 ± 14.1 years; p < 0.001) and more likely to have abnormal diastolic function. The rate of POAF increased exponentially with diastolic function grade (DFG) severity (p < 0.001). By multivariate analysis, after adjusting for clinical and surgical risk factors, independent predictors of POAF were older age (odds ratio [OR]: 1.05; p < 0.001), higher body mass index (OR: 1.06; p = 0.03), and abnormal LV DFG (DFG 1, OR: 5.12 [p = 0.006]; DFG 2, OR: 9.87 [p < 0.001]; and DFG 3, OR: 28.52 [p < 0.001]). Conclusions: LV diastolic dysfunction is a powerful, independent predisposing substrate for the initiation of POAF. Evaluation may be useful during risk stratification of patients undergoing cardiac surgery.",
keywords = "atrial fibrillation, cardiac surgery, diastolic dysfunction, echocardiography",
author = "Rowlens Melduni and Suri, {Rakesh M.} and Seward, {James B.} and Bailey, {Kent R} and Ammash, {Naser M.} and Oh, {Jae Kuen} and Schaff, {Hartzell V} and Gersh, {Bernard J.}",
year = "2011",
month = "8",
day = "23",
doi = "10.1016/j.jacc.2011.05.021",
language = "English (US)",
volume = "58",
pages = "953--961",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
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TY - JOUR

T1 - Diastolic dysfunction in patients undergoing cardiac surgery

T2 - A pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation

AU - Melduni, Rowlens

AU - Suri, Rakesh M.

AU - Seward, James B.

AU - Bailey, Kent R

AU - Ammash, Naser M.

AU - Oh, Jae Kuen

AU - Schaff, Hartzell V

AU - Gersh, Bernard J.

PY - 2011/8/23

Y1 - 2011/8/23

N2 - Objectives: Our goal was to investigate whether left ventricular (LV) diastolic dysfunction was an important pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation (POAF). Background: Atrial fibrillation is a common complication after cardiac surgery. However, the precise mechanism underlying its development remains poorly understood. Pre-existing alterations of myocardial diastolic function may predispose patients to the development of POAF. Methods: Patients were residents of Olmsted County, Minnesota, who underwent complete LV diastolic function assessment before coronary artery bypass grafting and/or valve surgery between January 1, 2000, and December 31, 2005. All were in sinus rhythm and had no history of atrial fibrillation, a pacemaker, mitral stenosis, or congenital heart disease. POAF was defined as any episode of atrial fibrillation within 30 days after surgery. Results: POAF occurred in 135 of 351 patients (38.5%). Patients with POAF were older (mean age 72.5 ± 10.3 years vs. 63.1 ± 14.1 years; p < 0.001) and more likely to have abnormal diastolic function. The rate of POAF increased exponentially with diastolic function grade (DFG) severity (p < 0.001). By multivariate analysis, after adjusting for clinical and surgical risk factors, independent predictors of POAF were older age (odds ratio [OR]: 1.05; p < 0.001), higher body mass index (OR: 1.06; p = 0.03), and abnormal LV DFG (DFG 1, OR: 5.12 [p = 0.006]; DFG 2, OR: 9.87 [p < 0.001]; and DFG 3, OR: 28.52 [p < 0.001]). Conclusions: LV diastolic dysfunction is a powerful, independent predisposing substrate for the initiation of POAF. Evaluation may be useful during risk stratification of patients undergoing cardiac surgery.

AB - Objectives: Our goal was to investigate whether left ventricular (LV) diastolic dysfunction was an important pathophysiological mechanism underlying the initiation of new-onset post-operative atrial fibrillation (POAF). Background: Atrial fibrillation is a common complication after cardiac surgery. However, the precise mechanism underlying its development remains poorly understood. Pre-existing alterations of myocardial diastolic function may predispose patients to the development of POAF. Methods: Patients were residents of Olmsted County, Minnesota, who underwent complete LV diastolic function assessment before coronary artery bypass grafting and/or valve surgery between January 1, 2000, and December 31, 2005. All were in sinus rhythm and had no history of atrial fibrillation, a pacemaker, mitral stenosis, or congenital heart disease. POAF was defined as any episode of atrial fibrillation within 30 days after surgery. Results: POAF occurred in 135 of 351 patients (38.5%). Patients with POAF were older (mean age 72.5 ± 10.3 years vs. 63.1 ± 14.1 years; p < 0.001) and more likely to have abnormal diastolic function. The rate of POAF increased exponentially with diastolic function grade (DFG) severity (p < 0.001). By multivariate analysis, after adjusting for clinical and surgical risk factors, independent predictors of POAF were older age (odds ratio [OR]: 1.05; p < 0.001), higher body mass index (OR: 1.06; p = 0.03), and abnormal LV DFG (DFG 1, OR: 5.12 [p = 0.006]; DFG 2, OR: 9.87 [p < 0.001]; and DFG 3, OR: 28.52 [p < 0.001]). Conclusions: LV diastolic dysfunction is a powerful, independent predisposing substrate for the initiation of POAF. Evaluation may be useful during risk stratification of patients undergoing cardiac surgery.

KW - atrial fibrillation

KW - cardiac surgery

KW - diastolic dysfunction

KW - echocardiography

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