Assessing of myocardial atrial deformations in CABG patients as рredictor
of perioperative cardiac arrhythmia
K . Hristova, Tz. Katova, V. Kostova, I. Simova, N. Nesheva, L. Boijadjiev
National Heart Hospital, Sofia, Bulgaria
Background:
Atrial fibrillation (AF) is the most common serious arrhythmia,
encountered in clinical practice, especially by patients undergoing
coronary artery bypass graft surgery (CABG). The aim of the study
was to describe the atrial deformations in patients, undergoing
operative revascularization and to correlate and make prognosis
about risk for AF during perioperative phase..
Methods: We evaluated 35 patients ( mean age 62y ±14 ) without
previous history of AF, undergoing elective CABG. Echocardiography
was performed in all subjects and were scanned 1 day before
revascularization (baseline),5 days after revascularization (CABG) –
early phase and one month after CABF (1mFU). The images from
apical long axis for four, three and two chamber view were acquired
(frame rate 74 ± 6 frames/s) and analyzed offline in order to extract
the strain (rate) curves. From these, the maximal systolic strain
(PSS), peak strain rate (PSR) and peak velocity (PV) on right and
left atrium were derived, using vector velocity imaging (VVI)
software. Conventional measures of atrial function included peak
transmitral and transtricuspidal A-wave velocity, A-wave velocity time
integral, atrial volume index for the left and right atria.
PSV
LA with AF
5dFU
3,2±1,4 cm/s*
LA with AF
1m FU
4,2±1,4cm/s *
LA without AF
1m FU
4,8 ±1,3 cm/s
PSS
PSR
9,2±4,2 % *
2,0±0,9s-1 *
12,3±2% *
4,2±1,8s-1 *
14,6±2% *
4,9±1,2s-1 *
Tabl.1 PSV, PSS and PSR on the LA ;
Results:
The prevalence of perioperative AF in our group was relatively
low in early the phase- 6 patients (20%).New events of AF did
not register in all patients group until end of 1.month. We found
significant differences for the LA volume index in the 1.month
follow up (32,99ml/m2 ±6,1vs.29,85 ml/m2 ±6,8, p<0,05) vs.
baseline in patients group with AF. In addition, there are not
differences in the group with AF as in early phase, so 1mFU.
Atrial strain (P<0.0001; coefficient, 0.015; SE, 0.003) and strain
rate (P<0.0001; coefficient, 0.372; SE, 0.075) parameters alone
were confirmed as independent predictors of sinus rhythm
maintenance by multivariable analysis.
Conclusions: The assessment of CABG patients is possible
nowadays to reduce and make prognosis about the risk of occurrence
AF. Patients with higher atrial strain and strain rate appear to have a
greater likelihood of staying in sinus rhythm. Lower atrial strain and
strain rate measurements may predict the perioperative risk of AF in
CABG patients.
* significance between baseline and follow up , p< 0,0001
Fig.1 VVI analyzes on the LA and RA strain rate
EuroEcho 2010