Original ArticleRelationship Between Right Ventricular Function and Atrial Fibrillation After Cardiac Surgery
Section snippets
Study Population
This prospective study was approved by the Institutional Review Board of Chang Gung Memorial Hospital, Linkou Medical Center (Institutional Review Board No. 101-1774B), and prior informed, written consent was obtained from each patient. Patients older than 20 years who underwent cardiac surgery from July 2012 to July 2013 prospectively were enrolled. Exclusion criteria included contraindications to TEE, nonsinus rhythm, and history of AF. Comprehensive 2-dimensional and tissue Doppler TEE
Patient Profile
The study population comprised 92 patients (mean age 61.2 ± 10.8 yr, 63 men); 42 (46%) patients underwent coronary artery bypass graft (CABG) alone, 10 (11%) underwent CABG combined with valvular surgery, and 40 (43%) underwent isolated valvular surgery. Twenty-five patients (27%) experienced POAF, with a median occurrence of 3 days after cardiac surgery. These 25 POAF patients were significantly older (p = 0.042) and had higher levels of American Society of Anesthesiologists (p = 0.032) and
Association of RV Indices With POAF
Correlations were significant between RVGLS and RVFAC, RVS’, and TAPSE either in T1 (R = –0.58, p < 0.001; R = –0.24, p = 0.023; R = –0.51, p < 0.001, respectively) or in T2 (R = –0.63, p < 0.001; R = –0.33, p = 0.001; R = –0.34, p = 0.001, respectively). After the models had been adjusted for risk factors previously described for POAF and significant variables on univariate analysis, multivariable logistic regression models of individual RV indices showed that RVGLST1 (odds ratio [OR]) 1.13,
Patients With RV Dysfunction
Patients identified by RVGLST2 >–16.1% as having perioperative RV dysfunction (RVD) exhibited significantly larger LA, LV end-diastolic diameter, LV end-systolic diameter, and impaired LV systolic and diastolic function compared with patients without RVD (Table S1). By contrast, patients in the RVD group apparently were younger (58 ± 11 yr v 63 ± 10 yr, p = 0.024) and did not have a higher prevalence of comorbidities.
Reproducibility
The interobserver and intraobserver variability expressed as the coefficient of variation for RVGLST1 was 7.1% and 6.0%, respectively. For RVGLST2, the interobserver and intraobserver coefficient of variation was 6.3% and 4.7%, respectively. The interobserver and intraobserver interclass correlation coefficients for RVGLST1 were 0.93 (95% CI 0.82-0.98) and 0.95 (95% CI 0.87-0.98), respectively. For RVGLST2, the interobserver and intraobserver interclass correlation coefficients were 0.93 (95%
Discussion
Based on the literature reviewed, this is the first study to explore the relationship between perioperative RVGLS and the occurrence of POAF after cardiac surgery. In this prospective study, 3 major results are reported. First, RV function measured using perioperative RVGLS was associated independently with POAF. Second, the change of RV performance during surgery was not a risk factor for POAF. Third, patients with RVD exhibited a larger LA and decreased LV systolic and diastolic functions,
Limitations
The population sampled in this study was not homogenous. Compared with the data in a nationwide population-based cohort undergoing cardiac surgery,29 the component of valvular surgery alone was higher in the authors’ institute (43%) than in the cohort (30%), whereas the proportions of combined CABG and valvular surgery were similar (9%-11%). The data in this study are suitable for application in institutions that perform elective cardiac surgery with an even volume of CABG and valvular surgery.
Conclusions
POAF after cardiac surgery is derived from multifactorial origins encompassing both transient factors related to surgery and a patient’s preexisting conditions. RVD in the perioperative state is an independent risk factor for the occurrence of POAF. Perioperative RVGLS measured by using TEE in the assessment of RV function is novel and offers useful information to predict POAF in patients referred for elective cardiac surgery.
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Preoperative Right Ventricular Dysfunction Indicates High Vasoactive Support Needed After Cardiac Surgery
2019, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :All echocardiographic studies were conducted by an experienced echocardiographer who used a commercially available echocardiography system equipped with a 5.0-MHz transducer (Vivid 7; GE Healthcare, Milwaukee, WI). In the protocol,10 the authors acquired TEE data sets from 3 to 5 consecutive cardiac cycles, with temporary interruption of ventilator support at end-expiration. During acquisition, special care was taken to ensure an adequate sector for the entire RV lateral wall and the interventricular septum throughout the cycle; moreover, a frame rate of >60 Hz was maintained to facilitate optimal tracking of the myocardium.