Abstract
BackgroundPostoperative atrial fibrillation (POAF) is a common complication in patients with obstructive hypertrophic cardiomyopathy (HOCM) who undergo surgical myectomy. POAF is associated with poor outcome. The role of plasma big endothelin-1 level in predicting atrial fibrillation after surgical septal myectomy in HOCM patients has not well been studied.MethodsA total of 118 patients with HOCM who underwent surgical septal myectomy were recruited in this study. Plasma big endothelin-1 level was measured. The heart rhythm was continuously monitored during hospital stay. Preoperative, intraoperative, and postoperative variables were collected.ResultsPOAF developed among 26 of the 118 patients (22%) in this study. Compared with those without POAF, patients with POAF were significantly older (53.5 ± 10.6 vs. 47.3 ± 13.6 years, P = 0.033), more likely to undergo mitral valve surgery (38.5% vs. 18.5%, P = 0.032), and had higher plasma big endothelin-1 levels (0.41 ± 0.19 vs. 0.27 ± 0.14 pmol/l, P = 0.001), longer hospital stay (9.1 ± 3.7 vs. 7.5 ± 2.8 days, P = 0.022), larger preoperative left atria (48.0 ± 5.2 vs. 44.1 ± 5.9 mm; P = 0.003). In the receiver operating characteristic curve analysis, the area under the curve for big endothelin-1 was 0.734 (95% CI, 0.634 to 0.834, P<0.001). In multivariate logistic regression analysis, preoperative big endothelin-1 level (OR 100.7, 95%CI: 5.0–2020.0, P = 0.003) and left atrial diameter (OR 1.106, 95%CI: 1.015–1.205, P = 0.022) were independent predictors of POAF.ConclusionElevated preoperative plasma big endothelin-1 level is an independent predictor of POAF in HOCM patients undergoing surgical septal myectomy.
Highlights
Postoperative atrial fibrillation (POAF) is a common complication in patients with obstructive hypertrophic cardiomyopathy (HOCM) who undergo surgical myectomy, occurring in 17–20% of patients [1, 2] POAF may present as a benign condition, it sometimes has an adverse influence on patients as it contributes to increased complications, mortality, and duration of hospital stay [2]
The role of plasma big endothelin-1 level in predicting POAF after surgical septal myectomy in HOCM patients has not been well investigated. This present study aimed to assess the impact of preoperative plasma big endothelin-1 level on new-onset Atrial fibrillation (AF) after surgical septal myectomy
We found that plasma big endothelin-1 level was an independent predictor of POAF
Summary
Patients who underwent surgical septal myectomy were assessed at Fuwai Hospital, Chinese Academy of Medical Sciences, between January 2013 and March 2018. Postoperative echocardiograms including 2-dimensional and Doppler type. If a postoperative LVOT gradient detected by intraoperative transoesophageal echocardiography > 30 mmHg after weaning from cardiopulmonary bypass, reoperation was required. All patients underwent continuous cardiac monitoring using a 5-lead telemetry strip during postoperative hospital stay. The cut-off value for big ENDOTHELIN-1 was determined by area under the receiver-operator characteristic (ROC) curve. Both univariate and multivariate logistic regression analyses were conducted to determine the predictors of POAF. Statistical analyses were performed with SPSS version 21.0 (IBM Corp, Armonk, NY)
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