Background-We assessed the validity of the atrial electromechanical interval, measured by transthoracic tissue Doppler echocardiography, in determining patients at risk of post-coronary artery bypass graft atrial fibrillation (AF). Methods and Results-This prospective study recruited 355 patients in sinus rhythm who were candidates for coronary artery bypass grafting. The patients underwent a preoperative transthoracic echocardiography with a tissue Doppler evaluation and were monitored with continuous ECG telemetry during their hospital stay. Sixty-eight patients had postoperative AF (19.2%), with the incident occurring 2.3Ϯ0.7 days after surgery. The median length of hospitalization was 7.0 days for the AF patients and 6.0 days for the non-AF patients (PϽ0.0001). The subjects with postoperative AF differed from the sinus rhythm patients in that the former had a lower ejection fraction (40.4Ϯ8.5% versus 48.4Ϯ9.4%), a reduced maximal A-wave transmitral Doppler flow velocity (44.3Ϯ4.6 versus 53.3Ϯ10.9 cm/s), an increased total atrial volume (68.7Ϯ12.6 versus 55.3Ϯ11.8 mL), and a prolonged atrial electromechanical interval (141.9Ϯ13.4 versus 100.3Ϯ10.3 ms, respectively; PϽ0.0001 for all). In addition, the AF patients were older than the sinus rhythm group (66.0Ϯ8.0 versus 59.8Ϯ8.5 years). The atrial electromechanical interval was the best independent discriminator of the history of AF. We defined a cutoff point for the atrial electromechanical interval and chose 120 milliseconds for categorization, which yielded 100% sensitivity and 94.8% specificity for the prediction of AF. Conclusions-The atrial electromechanical interval by transthoracic tissue Doppler echocardiography could be a valuable method for identifying patients vulnerable to post-coronary artery bypass graft AF.

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Routine screening of the abdominal aorta during transthoracic echocardiography is recommended on account of the prevalence of AAA in unselected and, in particular, older patients.

The optimal management of moderate (grade 2-3+) ischemic mitral regurgitation (MR) in patients undergoing coronary artery bypass grafting (CABG) remains controversial. While CABG alone can reverse regurgitation in some patients with moderate MR, adjunctive mitral repair may be necessary in others. We performed low-dose dobutamine stress echocardiography (DSE) in 60 patients with moderate MR who were about to undergo CABG. Group I, 25 patients who demonstrated reduction in MR during DSE, had CABG alone. Group II, 35 patients in whom MR was unchanged during DSE, had mitral valve repair as well as CABG. MR was reduced postoperatively in both groups (P < 0.0001). Postoperative ejection fraction in Group I (12.2%) improved more than that in Group II (9.3%) (P < 0.01). We conclude that CABG alone may be sufficient to correct moderate MR when MR is reduced during DSE.