Abstract
The aim of the study was to assess the impact of the functional state of the left atrium (LA) according to the analysis of Strain and Strain Rate on the risk of developing atrial fibrillation (AF) after coronary bypass surgery.
Material and methods. The study included 84 patients with coronary artery disease who underwent coronary artery bypass grafting (CABG). Analysis of structural and functional parameters was carried out in two groups: group 1 (n=34) – patients who developed AF paroxysms in the early postoperative period after CABG; Group 2 (n=50) – patients who did not develop AF after CABG. All patients before surgery and in the early postoperative period were assessed by tissue Doppler study of longitudinal global strain and strain rate of the LA myocardium (in the reservoir, conduction, and contraction phases) and LV.
Results. It has been established that the development of postoperative AF is associated with both preoperative factors and the postoperative state of the myocardium, primarily LA. Patients who developed AF in the postoperative period had a more pronounced structural and functional remodeling of the LA before surgery, which was characterized by an increase in the indexed volume and linear dimensions of the LA; worse indicators of deformation and strain rate of the LA during the phases of its mechanical function: reservoir, conduction and contraction; increased stiffness of the LA myocardium. According to the functional status of the left ventricle, these groups did not differ significantly. In the postoperative period, patients with postoperative AF showed: a more significant impairment of the mechanical function of the LA during the phases of the reservoir, conduction and contraction, according to the analysis of the Strain and Strain Rate parameters of the LA (which was more significantly impaired compared to preoperative parameters); higher values of LA stiffness, reflecting both the presence of fibrosis in the LA myocardium and postoperative myocardial staging; volumetric and linear parameters of the LA remained increased, and the total fraction of LA emptying was reduced, reflecting the structural remodeling of the LA and a decrease in the overall pumping function of the LA. The groups did not differ significantly in the functional status of the left ventricle. The following preoperative predictors of AF development in the postoperative period were established: LASr less than 9% (odds ratio (OR) 3.25, 95% confidencial interval (CI) 1.17–9.05; p=0.021), LAScd less than 7% (OR 3.3, 95% CI 1.34–8.3; p=0.009), E/e' more than 7.0 (OR 3.2, 95% CI 1.27–8.0; p=0.013), LА stiffness over 0.7 (OR 3.55, 95% CI 1.27–9.15; p=0.008), pulmonary capillary wedge pressure more than 10 mm Hg (OR 4.52, 95% CI 1.76–11.6; p=0.002). Postoperative indicators-markers associated with the development of atrial fibrillation in the postoperative period were established: LAScd less than 4% (OR 2.64, 95% CI 1.08–6.46; p=0.033), LASct less than 4% (OR 12.0, 95% CI 2.93–49.0; p=0.001), LASRr less than 0.4 s-1 (OR 3.54, 95% CI 1.38–9.0; p=0.008), LASRcd less than 0.4 s-1 (OR 2.9, 95% CI 1.11–7.58; p=0.028), LА stiffness over 0.9 (OR 3.72, 95% CI 1.48–9.34; p=0.005).
Conclusion. The development of atrial fibrillation in the postoperative period is facilitated by the presence of LA dysfunction (according to the analysis of Strain, Strain Rate) and increased stiffness of the LA myocardium.
References
- Lomivorotov V.V., Efremov S.M., Pokushalov E.A., Boboshko V.A. Atrial fibrillation after cardiac surgery: pathophysiology and methods of prevention. Bulletin of Anesthesiology and Resuscitation. 2017; 14 (2): 64–71 (in Russ.). DOI: 10.21292/2078-5658-2017- 14-2-64-71
- Engin M., Aydın U., Ata Y., Yavuz S. New-onset atrial fibrillation after coronary artery bypass graft surgery. Rev. Assoc. Med. Bras. 2023 17; 69 (4): e20221413. DOI: 10.1590/1806-9282.20221413
- Akintoye E., Sellke F., Marchioli R., Tavazzi L., Mozaffarian D. Factors associated with postoperative atrial fibrillation and other adverse events after cardiac surgery. J. Thorac. Cardiovasc. Surg. 2018; 155 (1): 242–251.e10. DOI: 10.1016/j.jtcvs.2017.07.063
- Bening C., Mazalu E.A., Yaqub J., Alhussini K., Glanowski M., Kottmann T., Leyh R. Atrial contractility and fibrotic biomarkers are associated with atrial fibrillation after elective coronary artery bypass grafting. J. Thorac. Cardiovasc. Surg. 2020; 159 (2): 515–523. DOI: 10.1016/j.jtcvs.2019.02.068
- Uysal D., Aksoy F., Ibrişim E. The validation of the ATRIA and CHA2DS2-Vasc Scores in predicting atrial fibrillation after coronary artery bypass surgery. Braz. J. Cardiovasc. Surg. 2020; 35 (5): 619–625. DOI: 10.21470/1678-9741-2019-0274
- Achmad C., Tiksnadi B.B., Akbar M.R., Karwiky G., Sihite T.A., Pramudya A. et al. Left volume atrial index and P-wave dispersion as predictors of postoperative atrial fibrillation after coronary artery bypass graft: A retrospective cohort study. Curr. Probl. Cardiol. 2023; 48 (3): 101031. DOI: 10.1016/j.cpcardiol.2021.101031
- B., Nijs J., Maessen J., Allessie M., Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace. 2012; 14 (2): 159–174. DOI: 10.1093/europace/eur208 8.
- Liu Y., Wu F., Wu Y., Elliott M., Zhou W., Deng Y. et al. Mechanism of IL-6-related spontaneous atrial fibrillation after coronary artery grafting surgery: IL-6 knockout mouse study and human observation. Transl. Res. 2021; 233: 16–31. DOI: 10.1016/j.trsl. 2021.01.007
- Ganaev K.G., Vlasova E.E., Avalyan A.A., Saidova M.A., Akchurin R.S. The first experience of using speckle tracking echocardiography technology in two-dimensional mode to assess the relationship between left atrial deformation disorders and atrial fibrillation after coronary artery bypass grafting. Russian Journal of Cardiology. 2022; 27 (7): 47–53 (in Russ.). DOI: 10.15829/1560-4071-2022-5026
- Workman A.J., Pau D., Redpath C.J., Marshall G.E., Russell J.A., Kane K.A. et al. Post-operative atrial fibrillation is influenced by beta-blocker therapy but not by pre-operative atrial cellular electrophysiology. J. Cardiovasc. Electrophysiol. 2006; 17 (11): 1230–1238. DOI: 10.1111/j.1540-8167.2006.00592.x
- Lezoualc'h F., Steplewski K., Sartiani L., Mugelli A., Fischmeister R., Bril A. Quantitative mRNA analysis of serotonin 5-HT4 receptor isoforms, calcium handling proteins and ion channels in human atrial fibrillation. Biochem. Biophys. Res. Commun. 2007; 357 (1): 218–224. DOI: 10.1016/j.bbrc.2007.03.124
- Zakkar M., Ascione R., James A.F., Angelini G.D., Suleiman M.S. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol. Ther. 2015; 154: 13–20. DOI: 10.1016/j.pharmthera.2015.06.009
- Elahi M.M., Flatman S., Matata B.M. Tracing the origins of postoperative atrial fibrillation: the concept of oxidative stress-mediated myocardial injury phenomenon. Eur. J. Cardiovasc. Prev. Rehabil. 2008; 15 (6): 735–741. DOI: 10.1097/HJR.0b013e328317f38a
- ress, reactive oxygen species, and arrhythmia. J. Mol. Cell. Cardiol. 2012; 52 (2): 454–463. DOI: 10.1016/j.yjmcc.2011.09.018
- Slagsvold K.H., Rognmo O., Høydal M., Wisløff U., Wahba A. Remote ischemic preconditioning preserves mitochondrial function and influences myocardial microRNA expression in atrial myocardium during coronary bypass surgery. Circ. Res. 2014; 114 (5): 851–859. DOI: 10.1161/CIRCRESAHA.114.302751
- Kim Y.M., Guzik T.J., Zhang Y.H., Zhang M.H., Kattach H. A myocardial Nox2 containing NAD(P)H oxidase contributes to oxidative stress in human atrial fibrillation. Circ. Res. 2005; 97 (7): 629–636. DOI: 10.1161/01.RES.0000183735.09871.61 17.
- Tsoporis J.N., Fazio A., Rizos I.K., Izhar S., Proteau G., Salpeas V. et al. Increased right atrial appendage apoptosis is associated with differential regulation of candidate MicroRNAs 1 and 133A in patients who developed atrial fibrillation after cardiac surgery. J. Mol. Cell. Cardiol. 2018; 121: 25–32. DOI: 10.1016/j.yjmcc.2018.06.005
- Jayaram R., Goodfellow N., Zhang M.H., Reilly S., Crabtree M., De Silva R. et al. Molecular mechanisms of myocardial nitroso-redox imbalance during on-pump cardiac surgery. Lancet. 2015; 385 (Suppl. 1): S49. DOI: 10.1016/S0140-6736(15)60364-6
- Zhang Y., Wang Y.T., Shan Z.L., Guo H.Y., Guan Y., Yuan H.T. Role of inflammation in the initiation and maintenance of atrial fibrillation and the protective effect of atorvastatin in a goat model of aseptic pericarditis. Mol. Med. Rep. 2015; 11 (4): 2615–2623. DOI: 10.3892/mmr.2014.3116
- Hung L.T., Alshareef A., Al-Ahdal T.M.A., Anh P.T.T., Huan D.Q., Do Van Trang et al. Predicting atrial fibrillation after cardiac surgery using a simplified risk index. J. Electrocardiol. 2021; 67: 45–49. DOI: 10.1016/j.jelectrocard.2021.03.012
About the authors
- Inna V. Koksheneva, Dr. Med. Sci., Senior Researcher; ORCID
- Lidiya I. Kaplenko, Postgraduate; ORCID
- Evgeniy P. Golubev, Cand. Med. Sci., Researcher; ORCID
- Rustam M. Ibragimov, Cand. Med. Sci., Researcher;
- Temur K. Turakhonov, Postgraduate; ORCID
- Alena V. Grishenok, Postgraduate;
- Ekaterina V. Zhertovskaya, Junior Researcher; ORCID
- Atabi Sh. Iraskhanov, Applicant; ORCID
