Preoperative Tissue Doppler Imaging-Derived Atrial Conduction Time Can Predict Postoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement for Aortic Valve Stenosis

• Published in: Circulation Journal Vol. 78; no. 9; pp. 2173 - 2181
• Main Authors: Takahashi, Shinya, Fujiwara, Mai, Watadani, Keisuke, Taguchi, Takahiro, Katayama, Keijiro, Takasaki, Taiichi, Kurosaki, Tatsuya, Imai, Katsuhiko, Sueda, Taijiro
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2014
• Subjects: Aged; Aged, 80 and over; Aortic valve replacement; Aortic valve stenosis; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Atrial fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - etiology; Atrial Fibrillation - physiopathology; Echocardiography, Doppler; Heart Conduction System - diagnostic imaging; Heart Conduction System - physiopathology; Heart Valve Prosthesis Implantation - adverse effects; Humans; Middle Aged; Postoperative Complications - diagnosis; Postoperative Complications - diagnostic imaging; Postoperative Complications - physiopathology; Preoperative Care; Prognosis; Retrospective Studies; Total atrial conduction time
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-14-0327

Background:Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery and may result in stroke or heart failure and poor prognosis. This study aimed to evaluate a novel index of total atrial conduction time derived from the P-wave onset (lead II) to the peak A’ wave on tissue Doppler imaging (PA-TDI duration). The PA-TDI duration was compared with previously reported predictors of POAF, and the optimal cutoff value of PA-DTI was calculated in patients undergoing aortic valve replacement (AVR) for AV stenosis (AS).Methods and Results:We enrolled 63 patients undergoing isolated AVR. They underwent transthoracic echocardiography with TDI preoperatively and were monitored postoperatively with continuous electrocardiographic telemetry for 7 days. The hospital stay was significantly longer in the 41 patients with POAF than in the 22 without POAF (33.8±19.7 vs. 24.1±8.1 days, P=0.03). Multivariate analysis revealed that PA-TDI duration (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.02–1.13; P=0.0072) and age (OR, 1.14; CI, 1.03–1.28; P=0.016) were significant independent predictors of POAF. Receiver-operating characteristic curve analysis showed the optimal cutoff values of PA-TDI duration and age were 147.3 ms and 74 years, respectively.Conclusions:The PA-TDI duration was an independent predictor of POAF after AVR for AS. Patients with PA-TDI duration >147 ms should be considered high risk and treated appropriately to improve outcomes. (Circ J 2014; 78: 2173–2181)