Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery. A Prospective Study

Martin Osranek, Kaniz Fatema, Fatema Qaddoura, Ahmed Al-Saileek, Marion E. Barnes, Kent R Bailey, Bernard J. Gersh, Teresa S M Tsang, Kenton J. Zehr, James B. Seward

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Objectives: This study sought to identify preoperative predictors of postoperative atrial fibrillation (POAF) among patients undergoing cardiac surgery. Background: Postoperative atrial fibrillation is frequent after cardiac surgery and is associated with increased morbidity, mortality, prolonged hospital stay, and increased costs. Left atrial volume (LAV), a marker of chronically elevated left ventricular filling pressure, is a predictor of atrial fibrillation (AF) in the nonsurgical setting. Methods: A total of 205 patients (mean age 62 ± 16 years; 35% women) undergoing cardiac surgery were prospectively enrolled. Clinical risk factors were obtained by detailed medical record review and patient interview. Preoperative transthoracic echocardiograms were performed for assessment of LAV, left ventricular ejection fraction, and diastolic function. Follow-up was complete. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Results: Postoperative atrial fibrillation occurred in 84 patients (41.4%) at a median of 1.8 days after cardiac surgery. The LAV was significantly larger in patients in whom AF developed (49 ± 14 ml/m2 vs. 39 ± 16 ml/m2, p = 0.0001). Patients with LAV >32 ml/m2 had an almost five-fold increased risk of POAF, independently of age and clinical risk factors (adjusted hazard ratio 4.84, 95% confidence interval 1.93 to 12.17, p = 0.001). Age and LAV were the only independent predictors of POAF. The area under the receiver-operator characteristics curve to predict POAF was 0.729 for LAV and 0.768 for the combination of LAV and age (both p < 0.0001). Conclusions: The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.

Original languageEnglish (US)
Pages (from-to)779-786
Number of pages8
JournalJournal of the American College of Cardiology
Volume48
Issue number4
DOIs
StatePublished - Aug 15 2006

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Atrial Fibrillation
Thoracic Surgery
Prospective Studies
Telemetry
Ventricular Pressure
Documentation
Stroke Volume
Medical Records
Length of Stay
Hospitalization
Confidence Intervals
Interviews
Morbidity
Costs and Cost Analysis
Mortality

ASJC Scopus subject areas

  • Nursing(all)

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Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery. A Prospective Study. / Osranek, Martin; Fatema, Kaniz; Qaddoura, Fatema; Al-Saileek, Ahmed; Barnes, Marion E.; Bailey, Kent R; Gersh, Bernard J.; Tsang, Teresa S M; Zehr, Kenton J.; Seward, James B.

In: Journal of the American College of Cardiology, Vol. 48, No. 4, 15.08.2006, p. 779-786.

Research output: Contribution to journalArticle

Osranek, M, Fatema, K, Qaddoura, F, Al-Saileek, A, Barnes, ME, Bailey, KR, Gersh, BJ, Tsang, TSM, Zehr, KJ & Seward, JB 2006, 'Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery. A Prospective Study', Journal of the American College of Cardiology, vol. 48, no. 4, pp. 779-786. https://doi.org/10.1016/j.jacc.2006.03.054
Osranek, Martin ; Fatema, Kaniz ; Qaddoura, Fatema ; Al-Saileek, Ahmed ; Barnes, Marion E. ; Bailey, Kent R ; Gersh, Bernard J. ; Tsang, Teresa S M ; Zehr, Kenton J. ; Seward, James B. / Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery. A Prospective Study. In: Journal of the American College of Cardiology. 2006 ; Vol. 48, No. 4. pp. 779-786.
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abstract = "Objectives: This study sought to identify preoperative predictors of postoperative atrial fibrillation (POAF) among patients undergoing cardiac surgery. Background: Postoperative atrial fibrillation is frequent after cardiac surgery and is associated with increased morbidity, mortality, prolonged hospital stay, and increased costs. Left atrial volume (LAV), a marker of chronically elevated left ventricular filling pressure, is a predictor of atrial fibrillation (AF) in the nonsurgical setting. Methods: A total of 205 patients (mean age 62 ± 16 years; 35{\%} women) undergoing cardiac surgery were prospectively enrolled. Clinical risk factors were obtained by detailed medical record review and patient interview. Preoperative transthoracic echocardiograms were performed for assessment of LAV, left ventricular ejection fraction, and diastolic function. Follow-up was complete. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Results: Postoperative atrial fibrillation occurred in 84 patients (41.4{\%}) at a median of 1.8 days after cardiac surgery. The LAV was significantly larger in patients in whom AF developed (49 ± 14 ml/m2 vs. 39 ± 16 ml/m2, p = 0.0001). Patients with LAV >32 ml/m2 had an almost five-fold increased risk of POAF, independently of age and clinical risk factors (adjusted hazard ratio 4.84, 95{\%} confidence interval 1.93 to 12.17, p = 0.001). Age and LAV were the only independent predictors of POAF. The area under the receiver-operator characteristics curve to predict POAF was 0.729 for LAV and 0.768 for the combination of LAV and age (both p < 0.0001). Conclusions: The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.",
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T1 - Left Atrial Volume Predicts the Risk of Atrial Fibrillation After Cardiac Surgery. A Prospective Study

AU - Osranek, Martin

AU - Fatema, Kaniz

AU - Qaddoura, Fatema

AU - Al-Saileek, Ahmed

AU - Barnes, Marion E.

AU - Bailey, Kent R

AU - Gersh, Bernard J.

AU - Tsang, Teresa S M

AU - Zehr, Kenton J.

AU - Seward, James B.

PY - 2006/8/15

Y1 - 2006/8/15

N2 - Objectives: This study sought to identify preoperative predictors of postoperative atrial fibrillation (POAF) among patients undergoing cardiac surgery. Background: Postoperative atrial fibrillation is frequent after cardiac surgery and is associated with increased morbidity, mortality, prolonged hospital stay, and increased costs. Left atrial volume (LAV), a marker of chronically elevated left ventricular filling pressure, is a predictor of atrial fibrillation (AF) in the nonsurgical setting. Methods: A total of 205 patients (mean age 62 ± 16 years; 35% women) undergoing cardiac surgery were prospectively enrolled. Clinical risk factors were obtained by detailed medical record review and patient interview. Preoperative transthoracic echocardiograms were performed for assessment of LAV, left ventricular ejection fraction, and diastolic function. Follow-up was complete. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Results: Postoperative atrial fibrillation occurred in 84 patients (41.4%) at a median of 1.8 days after cardiac surgery. The LAV was significantly larger in patients in whom AF developed (49 ± 14 ml/m2 vs. 39 ± 16 ml/m2, p = 0.0001). Patients with LAV >32 ml/m2 had an almost five-fold increased risk of POAF, independently of age and clinical risk factors (adjusted hazard ratio 4.84, 95% confidence interval 1.93 to 12.17, p = 0.001). Age and LAV were the only independent predictors of POAF. The area under the receiver-operator characteristics curve to predict POAF was 0.729 for LAV and 0.768 for the combination of LAV and age (both p < 0.0001). Conclusions: The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.

AB - Objectives: This study sought to identify preoperative predictors of postoperative atrial fibrillation (POAF) among patients undergoing cardiac surgery. Background: Postoperative atrial fibrillation is frequent after cardiac surgery and is associated with increased morbidity, mortality, prolonged hospital stay, and increased costs. Left atrial volume (LAV), a marker of chronically elevated left ventricular filling pressure, is a predictor of atrial fibrillation (AF) in the nonsurgical setting. Methods: A total of 205 patients (mean age 62 ± 16 years; 35% women) undergoing cardiac surgery were prospectively enrolled. Clinical risk factors were obtained by detailed medical record review and patient interview. Preoperative transthoracic echocardiograms were performed for assessment of LAV, left ventricular ejection fraction, and diastolic function. Follow-up was complete. Detection of POAF was based on documentation of AF episodes by continuous telemetry throughout hospitalization. Results: Postoperative atrial fibrillation occurred in 84 patients (41.4%) at a median of 1.8 days after cardiac surgery. The LAV was significantly larger in patients in whom AF developed (49 ± 14 ml/m2 vs. 39 ± 16 ml/m2, p = 0.0001). Patients with LAV >32 ml/m2 had an almost five-fold increased risk of POAF, independently of age and clinical risk factors (adjusted hazard ratio 4.84, 95% confidence interval 1.93 to 12.17, p = 0.001). Age and LAV were the only independent predictors of POAF. The area under the receiver-operator characteristics curve to predict POAF was 0.729 for LAV and 0.768 for the combination of LAV and age (both p < 0.0001). Conclusions: The LAV is a strong and independent predictor of POAF. Risk stratification using LAV and age enables clinicians to identify high-risk patients before cardiac surgery.

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