Abstract 10645: Left Atrial Booster-Pump Function as a Predictive Parameter for New-Onset Postoperative Atrial Fibrillation in Patients With Severe Aortic Stenosis
Background: Postoperative atrial fibrillation (AF) has been reported to be associated with long-term mortality following aortic valve replacement (AVR), but its associated factors remains unknown. It was recently reported that left atrial (LA) strain rate parameters was associated with the development of AF in prior studies. We therefore used two-dimensional speckle-tracking strain rate to assess LA function as a predictive value for new-onset postoperative AF after AVR.
Methods: We studied 27 patients with severe AS undergoing AVR with left ventricular (LV) ejection fraction (EF) of 63±11%. All patients were in sinus rhythm and had no history of AF, and we excluded patients with significant other valvular disease and cardiomyopathy. LA reservoir (SR-LAs), conduit (SR-LAe), and booster-pump (AR-LAa) function were determined as the averaged global LA speckle-tracking longitudinal strain rate from apical 4- and 2-chamber views. Postoperative AF was defined as any episode of AF within 30 days after AVR.
Results: Postoperative AF was observed in 15 patients (56%). There were no differences in clinical characteristics, LA and LV volumes, and global LV function including LVEF and E/e’ between 2 groups. On the other hands, SR-LAs and SR-LAa in patients with postoperative AF were significantly lower than those in patients with maintained sinus rhythm (0.80±0.41/s vs. 1.3±0.47/s, p=0.006; 0.78±0.26/s vs. 1.1±0.22/ s, p=0.003, respectively). Importantly, multivariate analysis revealed SR-LAa as the only independent predictor of postoperative AF (odds ratio=0.004, p=0.019). Furthermore, SR-LAa >0.79/s predicted postoperative AF with 60% sensitivity, 92% specificity, and area under the curve of 0.828 (p<0.0001).
Conclusions: Subtle LA booster-pump dysfunction can be detected by SR-LAa, and was associated with new-onset postoperative AF in patients with severe AS. These findings may be useful for risk stratification and management of such patients.
- © 2013 by American Heart Association, Inc.