Low Circulating Levels of Growth Differentiation Factor-15 Before Coronary Artery Bypass Surgery May Predict Postoperative Atrial Fibrillation

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 29; no. 5; pp. 1131 - 1139
• Main Authors: Bouchot, Olivier, MD, PhD, Guenancia, Charles, MD, MSc, Kahli, Abdelkader, MSc, Pujos, Charline, MD, Malapert, Ghislain, MD, Vergely, Catherine, PharmD, PhD, Laurent, Gabriel, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015; WB Saunders
• Subjects: Aged; Anesthesia & Perioperative Care; atrial fibrillation; Atrial Fibrillation - blood; Atrial Fibrillation - diagnosis; biochemistry; Cardiology and cardiovascular system; cardiopulmonary bypass; Coronary Artery Bypass; coronary artery bypass grafts; Critical Care; Female; Growth Differentiation Factor 15 - blood; Human health and pathology; Humans; Life Sciences; Male; Middle Aged; off-pump surgery; Postoperative Complications - blood; Postoperative Complications - diagnosis; Predictive Value of Tests; Preoperative Care - statistics & numerical data; Prospective Studies; Risk Factors; cardiopulmonary bypass; atrial fibrillation; coronary artery bypass grafts; off-pump surgery; biochemistry
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2015.01.023

Objectives To assess the role of growth differentiation factor-15 (GDF-15) as a potential new predictor of postoperative atrial fibrillation (POAF) after off-pump (OFP) and on-pump (ONP) coronary artery bypass graft (CABG) surgery. Design Prospective, single-center, observational study. Setting University teaching hospital. Participants The first 50 patients planned for OFP surgery and the first 50 patients planned for ONP surgery among patients referred for CABG with the following exclusion criteria: age<18 or>80 years, previous atrial fibrillation/flutter, previous treatment with amiodarone, previous cardiac surgery, and emergency surgery. Interventions Included patients were equipped with long-duration (7 days) Holter-ECG monitoring. Measurements and Main Results POAF was defined as an AF episode lasting>30 seconds. All patients underwent preoperative echocardiography to assess left ventricular ejection fraction and left atrial diameter. GDF-15 levels were assessed after induction of anesthesia and 12 hours after arrival at the intensive care unit. Among the 100 patients, 34 (34%) developed POAF. In Cox multivariate regression analysis, the EuroSCORE, left atrial diameter>45 mm, and low GDF-15 levels at induction were associated independently with the onset of POAF. In contrast, preoperative NT-proBNP levels did not predict POAF. The use of ONP surgery was not associated with a higher incidence of POAF, even though baseline and follow-up characteristics in ONP and OFP patients were identical. Conclusions In patients with no history of AF, a low plasma level of GDF-15 before CABG surgery was a strong independent predictor of POAF. Moreover, preoperative plasma GDF-15 levels added an incremental predictive value to classic risk factors of POAF.