Abstract
Introduction: Early mitral inflow velocity indexed to early diastolic strain rate (E/e’sr) is a novel echocardiographic parameter to non-invasively estimate early left ventricular (LV) filling pressure. Hypothesis: E/e’sr is associated with development of atrial fibrillation (AF) following coronary artery bypass grafting (CABG) and that it is superior to the conventionally used E/e’, as E/e’sr reflects the global relaxational properties of the LV whereas E/e’ only considers the myocardial movement at the level of the mitral annulus. Methods: A cohort of 623 consecutive patients undergoing isolated CABG at a single center was included. Prior to the CABG procedure, all patients had an echocardiography performed including two-dimensional speckle tracking (2DSTE). The outcome was incident AF after hospital discharge. Cox hazard regression models were used to assess the association between E/e’sr and incident AF. Restricted cubic splines were used to assess linearity of the relationship between E/e’sr and AF. Results: The mean age of the cohort was 67±9 years, 84% were male and mean left ventricular ejection fraction (LVEF) was 50±11%. During follow-up (median: 3.7 years, IQR: 2.6, 4.9) a total of 67 patients (11%) developed AF. E/e’sr and E/e’ were both significantly associated with the outcome in univariable models (p=0.029 and p=0.006, respectively). Increasing E/e’sr was found to be linearly associated with an increased risk of AF ( Figure ). Following multivariable adjustment for age, sex, hypertension, diabetes, EuroSCORE II, serum cholesterol, smoking status, heart rate, number of culprit arteries, LVEF, LV mass index, and left atrial volume index, E/e’sr remained significantly associated with AF (HR:1.06 [1.01-1.12], p=0.038, per 10cm increase) whereas E/e’ did not (HR:1.05 [0.99-1.11], p=0.068, per 1 unit increase). Conclusions: Preoperative E/e’sr as measured by 2DSTE was found to be independently associated with development of AF following CABG.
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