Atrial fibrillation after operation for lung cancer: clinical and prognostic significance

Cardinale, Daniela; Martinoni, Alessandro; Cipolla, Carlo M.; Civelli, Maurizio; Lamantia, Giuseppina; Fiorentini, Cesare; Mezzetti, M

doi:10.1016/s0003-4975(99)00712-2

Cited by 81 publications

(71 citation statements)

References 20 publications

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“…5,9 Although postoperative AF is self-limited in most cases, its treatment requires additional costs for care and prolonged hospital stay, even when not complicated. 9 -12 Even if prior studies have identified several possible risk factors, 9,11,16 a clear link between them and the occurrence of AF has not yet been established. Indeed, most of the recognized risk factors are associated with low odds ratios, so no single variable can be used to appropriately stratify a patient's risk.…”

Section: Discussionmentioning

confidence: 99%

“…9,11,16,17 Given the high relative risk associated with this marker, it is possible that, either as an independent predictor or when adjusted for the other recognized risk factors, NT-proBNP summarizes in a single parameter the cumulative preoperative risk represented by several factors, so its increase may identify subjects more prone to develop AF. Wang et al 30 found that, in a sample of general population without heart failure, the increase in BNP levels significantly correlated with an increased risk of future cardiovascular events, which included AF.…”

Section: Discussionmentioning

confidence: 99%

“…Many of the risk factors for postoperative AF that have been indicated (male gender, major extent of lung resection, right side of procedure, history of diabetes mellitus, hypertension, chronic obstructive pulmonary disease [COPD], and coronary artery disease [CAD]) have not been confirmed in other studies. 9,11,16 Actually, the most robust risk factor for an increased incidence of postoperative AF is advanced age. 18 Hence, our ability to accurately identify patients at high risk for AF is limited 9,16,17 ; consequently, a targeted prophylactic treatment cannot easily be settled on.…”

Section: Clinical Perspective P 1344mentioning

confidence: 99%

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Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation After Thoracic Surgery for Lung Cancer

et al. 2007

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Background-Postoperative atrial fibrillation (AF) is a complication of thoracic surgery for lung cancer, with a reported incidence that can run as high as 42%. Recently, it has been observed retrospectively that B-type natriuretic peptide predicts AF after cardiac surgery. We performed a prospective study to evaluate the role of N-terminal pro-B-type natriuretic peptide (NT-proBNP) as a marker for risk stratification of postoperative AF in patients undergoing thoracic surgery for lung cancer. Methods and Results-We measured NT-proBNP levels in 400 patients (mean age, 62Ϯ10 years; 271 men) 24 hours before and 1 hour after surgery. The primary end point of the study was the incidence of postoperative AF. Overall, postoperative AF occurred in 72 patients (18%). Eighty-eight patients (22%) showed an elevated perioperative NT-proBNP value. When patients with either preoperatively or postoperatively elevated NT-proBNP were pooled, a greater incidence of AF was observed compared with patients with normal values (64% versus 5%; PϽ0.001). At multivariable analysis, adjusted for age, gender, major comorbidities, echocardiography parameters, pneumonectomy, and medications, both preoperative and postoperative NT-proBNP values were independent predictors of AF (relative risk, 27.9; 95% CI, 13.2 to 58.9; PϽ0.001 for preoperative NT-proBNP elevation; relative risk, 20.1; 95% CI, 5.8 to 69.4; PϽ0.001 for postoperative NT-proBNP elevation). Conclusions-Elevation of perioperative NT-proBNP is a strong independent predictor of postoperative AF in patients undergoing thoracic surgery for lung cancer. This finding should facilitate studies of therapies to reduce AF in selected high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Clinical Perspective P 1344mentioning

confidence: 99%

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Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation After Thoracic Surgery for Lung Cancer

et al. 2007

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“…The relationship between the occurrence of postoperative AF and baseline predictors was assessed with multivariable logistic regression model adjusted for factors presumably associated with AF risk, including advanced age, male gender, COPD, cardiac diseases, hypertension and diabetes mellitus, site of anastomosis, postoperative hypoxia, thoracic-gastric dilation and plasma NT-proBNP [1,[22][23][24][25] . P < 0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Transrectal EUS-guided FNA biopsy of a presacral chordoma-report of a case and review of the literature

Hou

Gao²,

Li³

et al. 2008

WJG

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AIM:To evaluate the value of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level for predicting postoperative atrial fibrillation (AF) in patients undergoing surgery for esophageal carcinoma. METHODS:NT-proBNP levels were measured in 142 patients 24 h before and 1 h after surgery for esophageal carcinoma. All patients having a preoperative cardiac diagnosis by electrocardiogram (ECG), remained under continuous monitoring for at least 48 h after surgery, and then underwent clinical cardiac evaluation until discharge.RESULTS: Postoperative AF occurred in 11 patients (7.7%). AF patients were significantly older (69.6 ± 12.2 years vs 63.4 ± 13.3 years, P = 0.031) than non-AF patients. There were no significant differences in history of diabetes mellitus, sex distribution, surgical approach, anastomosis site, intraoperative hypotension and postoperative fever. The preoperative plasma NT-proBNP level was significantly higher in patients who developed postoperative AF (121.3 ± 18.3 pg/mL vs 396.1 ± 42.6 pg/mL, P = 0.016). After adjustment for age, gender, chronic obstructive pulmonary disease (COPD), history of cardiac diseases, hypertension, postoperative hypoxia and thoracic-gastric dilation, NT-proBNP levels were found to be associated with the highest risk factor for postoperative AF (odds ratio = 4.711, 95% CI = 1.212 to 7.644, P = 0.008).CONCLUSION: An elevated perioperative plasma BNP level is a strong and independent predictor of postoperative AF in patients undergoing surgery for esophageal carcinoma. This finding has important implications for identifying patients at higher risk of postoperative AF who should be considered for preventive antiarrhythmic therapy.

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“…[162][163][164][167][168][169][170] Almost all of these studies were conducted in patients undergoing peripheral vascular surgery, because these patients are generally considered to be at the highest risk. 162,164,[167][168][169] Although they were important contributions at the time, the outcomes in most of these studies are not reflective of contemporary perioperative event rates, nor was the patient management consistent with current standards of preventive and perioperative cardiac care. Furthermore, many used stress protocols that are not commonly used today, such as non-Bruce protocol treadmill tests or arm ergometry.…”

Section: Supplemental Preoperative Evaluationmentioning

confidence: 99%

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

Fleisher¹,

Fleischmann²,

Auerbach³

et al. 2014

Circulation

926

495

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Atrial fibrillation after operation for lung cancer: clinical and prognostic significance

Cited by 81 publications

References 20 publications

Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation After Thoracic Surgery for Lung Cancer

Increased Perioperative N-Terminal Pro-B-Type Natriuretic Peptide Levels Predict Atrial Fibrillation After Thoracic Surgery for Lung Cancer

Transrectal EUS-guided FNA biopsy of a presacral chordoma-report of a case and review of the literature

2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

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