Diastolic Dysfunction in Patients Undergoing Cardiac Surgery

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

doi:10.1016/j.jacc.2011.05.021

Cited by 76 publications

(35 citation statements)

References 32 publications

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“…14–16 In the present study, although the overall incidence of POAF in the propensity matched cohort was 53.9%, the rate of POAF among patients who underwent LAA closure was 68.6%, in comparison with 39.3% for patients who did not undergo LAA closure. Johnson and colleagues 17 performed prophylactic LAA closure in 437 patients during open heart surgery.…”

Section: Discussioncontrasting

confidence: 57%

Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality

et al. 2017

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BACKGROUND Prophylactic exclusion of the left atrial appendage (LAA) is often performed during cardiac surgery ostensibly to reduce the risk of stroke. However, the clinical impact of LAA closure in humans remains inconclusive. METHODS Of 10 633 adults who underwent coronary artery bypass grafting and valve surgery between January 2000 and December 2005, 9792 patients with complete baseline characteristics, surgery procedure, and follow-up data were included in this analysis. A propensity score–matching analysis based on 28 pretreatment covariates was performed and 461 matching pairs were derived and analyzed to estimate the association of LAA closure with early postoperative atrial fibrillation (POAF) (atrial fibrillation ≤30 days of surgery), ischemic stroke, and mortality. RESULTS In the propensity-matched cohort, the overall incidence of POAF was 53.9%. In this group, the rate of early POAF among the patients who underwent LAA closure was 68.6% versus 31.9% for those who did not undergo the procedure (P<0.001). LAA closure was independently associated with an increased risk of early POAF (adjusted odds ratio, 3.88; 95% confidence interval, 2.89–5.20), but did not significantly influence the risk of stroke (adjusted hazard ratio, 1.07; 95% confidence interval, 0.72–1.58) or mortality (adjusted hazard ratio, 0.92; 95% confidence interval, 0.75–1.13). CONCLUSIONS After adjustment for treatment allocation bias, LAA closure during routine cardiac surgery was significantly associated with an increased risk of early POAF, but it did not influence the risk of stroke or mortality. It remains uncertain whether prophylactic exclusion of the LAA is warranted for stroke prevention during non–atrial fibrillation-related cardiac surgery.

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Section: Discussioncontrasting

confidence: 57%

Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality

et al. 2017

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“…Another surrogate parameter is the peak A wave velocity measured by pulsed wave Doppler echocardiography that has been widely used to assess atrial function[ 19 – 22 ] and has been shown to be associated with AF risk in the Framingham Heart Study and the Cardiovascular Health Study[ 17 , 23 ]. Furthermore, mitral annular E/E’ has been reported as an appropriate parameter to estimate the degree of atrial remodeling[ 24 ] since diastolic dysfunction is an independent risk factor for AF[ 25 , 26 ]. Additionally, it has been shown that recurrence of AF after electrical cardioversion can be predicted by the degree of diastolic dysfunction[ 27 ] or LA dilatation[ 28 ].…”

Section: Introductionmentioning

confidence: 99%

MicroRNAs as Biomarkers for Acute Atrial Remodeling in Marathon Runners (The miRathon Study – A Sub-Study of the Munich Marathon Study)

et al. 2016

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IntroductionPhysical activity is beneficial for individual health, but endurance sport is associated with the development of arrhythmias like atrial fibrillation. The underlying mechanisms leading to this increased risk are still not fully understood. MicroRNAs are important mediators of proarrhythmogenic remodeling and have potential value as biomarkers in cardiovascular diseases. Therefore, the objective of our study was to determine the value of circulating microRNAs as potential biomarkers for atrial remodeling in marathon runners (miRathon study).Methods30 marathon runners were recruited into our study and were divided into two age-matched groups depending on the training status: elite (ER, ≥55 km/week, n = 15) and non-elite runners (NER, ≤40 km/week, n = 15). All runners participated in a 10 week training program before the marathon. MiRNA plasma levels were measured at 4 time points: at baseline (V1), after a 10 week training period (V2), immediately after the marathon (V3) and 24h later (V4). Additionally, we obtained clinical data including serum chemistry and echocardiography at each time point.ResultsMiRNA plasma levels were similar in both groups over time with more pronounced changes in ER. After the marathon miR-30a plasma levels increased significantly in both groups. MiR-1 and miR-133a plasma levels also increased but showed significant changes in ER only. 24h after the marathon plasma levels returned to baseline. MiR-26a decreased significantly after the marathon in elite runners only and miR-29b showed a non-significant decrease over time in both groups. In ER miRNA plasma levels showed a significant correlation with LA diameter, in NER miRNA plasma levels did not correlate with echocardiographic parameters.ConclusionMiRNAs were differentially expressed in the plasma of marathon runners with more pronounced changes in ER. Plasma levels in ER correlate with left atrial diameter suggesting that circulating miRNAs could potentially serve as biomarkers of atrial remodeling in athletes.

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“…55 TTE might be able to demonstrate structural changes of the heart, especially the LA, which constitutes the "substrate", while the surgery is the inevitable "trigger" (Figure 2). 56 Cardiac SPECT was used in one study of patient undergoing liver transplantation and proved able to exclude patient developing POAF. 17 As with dobutamine stress testing cardiac SPECT cannot be used in an acute setting Figure 2 With age and comorbidities, "substrate" (ie, chronic inflammation, fibrosis, etc.)…”

Section: Imagingmentioning

confidence: 99%

“…POAF might occur when patients with a "substrate" are exposed to the hemodynamic challenges of surgery and post-surgery inflammatory stress response (Figure 2). 56 The incidence of POAF ranges from 4% to 17% in abdominal surgery. This variation cannot be explained solely by age and comorbidity; indeed, some patients with comorbidity will undergo surgery at an advanced age without developing POAF.…”

Section: Predictors Of Poaf After Abdominalmentioning

confidence: 99%

<p>Predictors of Postoperative Atrial Fibrillation After Abdominal Surgery and Insights from Other Surgery Types</p>

Madsen¹,

Jørgensen²,

Leerhøy³

et al. 2020

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Postoperative atrial fibrillation (POAF) in relation to abdominal surgery can cause clinical deterioration, prolonged hospitalization, admittance to intensive care units, stroke and increased mortality. The current review focus on patients developing POAF in relation to abdominal surgery and aims to present the current knowledge on predictors of this condition. Furthermore, predictors identified in other surgical populations that may be transferable and guide future research within the field of abdominal surgery will be presented. A systematic literature search of patients undergoing abdominal surgery and developing POAF was performed on PubMed and Embase. All types of study interventions, comparators and designs were included. All studies included reported POAF as primary or secondary outcome. All peer-reviewed English full-text manuscripts regardless of publication date were included. We included five studies out of the 149 unique records identified. Age, congestive heart failure, hypertension, vascular disease and surgical approach are risk factors associated with the development of POAF. Furthermore, inflammation biomarkers, dobutamine stress echocardiography and cardiac single-photon emission computed tomography can predict POAF. Insights from other surgical cohorts reveal that other biomarkers (ie, brain natriuretic peptide (BNP) and N-terminal pro-BNP), electrocardiography and echocardiography can be used to predict POAF and may be applied in future research projects within the field of abdominal surgery. In conclusion, very scarce evidence is currently available in predicting POAF after abdominal surgery. However, predicting POAF seems possible and feasible, why the authors encourage readers to initiate new research to close the current knowledge gap and improve clinical management.

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Diastolic Dysfunction in Patients Undergoing Cardiac Surgery

Abstract: 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.

Cited by 76 publications

References 32 publications

Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality

Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality

MicroRNAs as Biomarkers for Acute Atrial Remodeling in Marathon Runners (The miRathon Study – A Sub-Study of the Munich Marathon Study)

<p>Predictors of Postoperative Atrial Fibrillation After Abdominal Surgery and Insights from Other Surgery Types</p>

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