Association of Body Mass Index With New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting Operations

Sun, Xuegang; Boyce, Steven W.; Hill, Peter C.; Bafi, Ammar S.; Xue, Zhengyi; Lindsay, Joseph; Corso, Paul J.

doi:10.1016/j.athoracsur.2011.03.022

Cited by 27 publications

(33 citation statements)

References 15 publications

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“…However, they showed some differences. Sun et al [14] analyzed only CABG patients and did not evaluate the predictive value of atrial dimensions. Serban et al [15], defined differently POAF and did not find a relationship between POAF and age.…”

Section: Discussionmentioning

confidence: 99%

Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

Stefàno

Bugetti

Monaco

et al. 2020

J Cardiothorac Surg

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Background Body mass index (BMI), age, left atrium (LA) dimension and left ventricular ejection fraction (LVEF) have been linked to post-operative atrial fibrillation (POAF) after cardiac surgery. The aim of this study was to better define the role of these risk factors. Methods This retrospective cohort study evaluated 249 patients (without prior atrial dysrhythmia) undergoing cardiac or aortic surgery. Prior to surgery, the following data were collected: age, BMI, LA diameter, LA area, LVEF, thyroid stimulating hormone (TSH), creatinine and the presence of arterial hypertension (AH) and diabetes. Intraoperative data such as operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion were also collected. Only patients without pre- and post-surgery prophylactic anti-arrhythmic therapy were included. Results Patients with (N = 127, 51%) and without POAF (N = 122, 49%) were compared. No difference was observed for sex, LA diameter, LA area, LVEF, TSH, diabetes and use of ACE inhibitors or statins prior to intervention. Moreover, no difference was observed in terms of operation time, total clamp time, cardiopulmonary bypass time, and presence of pericardial/pleural effusion. However, patients with POAF were older (70.6 ± 10.7 vs. 60.4 ± 16.4 years, p = 0.001), had higher BMI (26.8 ± 4.5 vs. 24.9 ± 3.6 kg/m2, p = 0.001), higher baseline creatinine (1.06 ± 0.91 vs. 0.88 ± 0.32 mg/dL, p = 0.038) and a higher frequency of arterial hypertension (73.2% vs. 50%, p = 0.001) and Bentall procedure (24.4% vs. 9.8%, p = 0.023). Multivariate analysis showed that the only independent predictors of POAF were age (OR = 1.05, 95%CI 1.02–1.07, p = 0.001) and BMI (OR = 1.11 95%CI 1.03–1.2,p = 0.006). Conclusions These findings suggest that advanced age and a higher BMI are strong risk factors for POAF in patients without previous AF even in the presence of comparable LA dimensions and LVEF.

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Section: Discussionmentioning

confidence: 99%

Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

Stefàno

Bugetti

Monaco

et al. 2020

J Cardiothorac Surg

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“…The mean age varied from 56 to 68 years. Fourteen studies [9,11,13,14,16,18,[25][26][27][28][29][30][31][32] were from North America (the US and Canada), six studies [15,[33][34][35][36][37] were from Europe, two studies [10,12] were from Oceania, and two studies [19,38] were from Asia. Sixteen studies reported the BMI as a categorical variable, eight studies reported the BMI as a continuous variable, and two articles reported the BMI as both a categorical and continuous variable.…”

Section: Study Selectionmentioning

confidence: 99%

“…Fourteen studies grouped the BMI categories according to the World Health Organization criteria; however, only six articles (seven cohorts) [14,16,18,19,29,31] reported using normal BMI as the reference group. As shown in Fig.…”

Section: Categorical Analysis Of the Effect Of Bmi On Poafmentioning

confidence: 99%

Dose-Response Relationship Among Body Mass Index, Abdominal Adiposity and Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis of 30 Prospective Studies

Liu¹,

Mei

Xie

et al. 2020

Preprint

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Background: Whether being overweight increases the risk of postoperative atrial fibrillation (POAF) is unclear, and whether adiposity independently contributes to POAF has not been comprehensively studied. Thus, we conducted a meta-analysis to clarify the strength and shape of the exposure-effect relationship between adiposity and POAF.Methods: The PubMed, Cochrane Library, and EMBASE databases were searched for prospective studies (RCTs, cohort studies, and nest-case control studies) reporting data regarding the relationship between adiposity and the risk of POAF.Results: Thirty publications involving 139,302 patients were included. Analysis of categorical variables showed that obesity (RR: 1.39, P<0.001), but not being underweight (RR: 1.44, P=0.13) or being overweight (RR: 1.03, P=0.48), was associated with an increased risk of POAF. In the exposure-effect analysis, the summary RR for a 5-unit increment in body mass index (BMI) was 1.09 (P<0.001) for the risk of POAF. There was a significant linear relationship between BMI and POAF (Pnonlinearity=0.91); the curve was flat and began to rise steeply at a BMI of approximately 30. Notably, BMI levels below 30 (overweight) were not associated with a higher risk of POAF. In the subgroup analysis of surgery types, the pooled RR values for a BMI increase of 5 for coronary artery bypass graft and valve surgery were 1.21 (P<0.01) and 1.34 (P=0.25), respectively, suggesting that a potential difference in the association exists by surgery type. Additionally, waist obesity was associated with the risk of POAF (RR: 1.55, P<0.001).Conclusion: Based on the current evidence, our findings show that adiposity was independently associated with an increased risk of POAF, while being underweight or overweight might not significantly increase the POAF risk. The magnitude of the effect of obesity on AF in patients undergoing valve surgery might be small, and this finding needs to be further confirmed.

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“…The fact that spontaneous episodes of AF had already occurred shows that the activity of pro-arrhythmic mechanisms in these patients exceeded the 'AF threshold' [39]. Obesity predisposes to the development of postoperative AF, being associated with higher cardiac output requirement, higher LV mass, and larger LA size [40,41]. Hypertension is present in 60% of patients affected by AF in the Framingham Study [33].…”

Section: Preoperative Factors Clinical and Demographic Factorsmentioning

confidence: 99%

Factors influencing post-coronary artery bypass grafting atrial fibrillation episodes

Mariscalco¹,

Musumeci²,

Banach³

2013

Kardiol Pol

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Association of Body Mass Index With New-Onset Atrial Fibrillation After Coronary Artery Bypass Grafting Operations

Cited by 27 publications

References 15 publications

Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

Overweight and aging increase the risk of atrial fibrillation after cardiac surgery independently of left atrial size and left ventricular ejection fraction

Dose-Response Relationship Among Body Mass Index, Abdominal Adiposity and Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis of 30 Prospective Studies

Factors influencing post-coronary artery bypass grafting atrial fibrillation episodes

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