Abstract
The triglyceride–glucose index is a valuable marker of insulin resistance. However, the predictive value of this index for postoperative atrial fibrillation in patients undergoing septal myectomy remains unclear. A total of 409 patients with hypertrophic obstructive cardiomyopathy who underwent septal myectomy were recruited in this study. The triglyceride–glucose index was calculated for all patients preoperatively. All patients underwent clinical data collection, blood sampling, and standard echocardiographic examinations during hospitalization. The prevalence of postoperative atrial fibrillation was approximately 15% in the present study. Multivariate logistic regression revealed that age (odds ratio [OR]: 1.053, 95% CI: 1.016–1.090, P = 0.004), hypertension (OR: 2.399, 95% CI: 1.228–4.686, P = 0.010), left atrial diameter (OR: 1.101, 95% CI: 1.050–1.155, P < 0.001), and triglyceride–glucose index (OR: 4.218, 95% CI: 2.381–7.473, P < 0.001) were independent risk factors for postoperative atrial fibrillation in patients undergoing septal myectomy. In receiver operating characteristic curve analysis, the triglyceride–glucose index could provide a moderate predictive value for postoperative atrial fibrillation after septal myectomy 0.723 (95% CI: 0.650–0.796, P < 0.001). Moreover, adding the triglyceride–glucose index to conventional risk factor model could numerically but not significantly increase our ability to predict postoperative atrial fibrillation (area under the receiver: 0.742 (0.671–0.814) vs. 0.793 (0.726–0.860), p = 0.065) after septal myectomy. In our retrospective cohort study, the triglyceride–glucose index was identified as an independent predictor of postoperative atrial fibrillation in patients undergoing septal myectomy.
Highlights
Postoperative atrial fibrillation (POAF) has a prevalence of up to 24.6% in patients with hypertrophic obstructive cardiomyopathy (HOCM) who undergo septal myectomy [1]
Insulin resistance (IR) may predispose to AF by increasing left atrial size or impairing left ventricular diastolic function in hypertrophic cardiomyopathy [10]; its role in predicting new-onset POAF after septal myectomy in these patients has not been well investigated
Univariate analysis showed that preoperative variables including age, body mass index (OR: 1.126, 95% CI: 1.037–1.223, P = 0.005), hypertension (OR: 3.583, 95% CI: 2.039–6.297, P < 0.001), diabetes mellitus (OR: 3.849, 95% CI: 1.869–7.924, P < 0.001), hyperlipemia (OR: 3.296, 95% CI: 1.754–6.192, P < 0.001), Left atrial diameter (LAD) (OR: 1.063, 95% CI: 1.020–1.108, P = 0.004), and TyG index (OR: 4.163, 95% CI: 2.551–6.794, P < 0.001) were risk factors for the occurrence of POAF, whereas male sex, left ventricular ejection fraction, maximum wall thickness, left ventricular outflow tract gradient (LVOTG), and moderate or severe mitral regurgitation were not
Summary
Postoperative atrial fibrillation (POAF) has a prevalence of up to 24.6% in patients with hypertrophic obstructive cardiomyopathy (HOCM) who undergo septal myectomy [1] It is associated with increased morbidity and mortality as well as prolonged intensive care unit and hospital stay [2, 3]. Insulin resistance (IR) is a known risk factor for cardiovascular disease [6] that is observed in patients with hypertrophic cardiomyopathy [7]. It is associated with atrial remodeling [8] as well as atrial fibrillation (AF) [9]. IR may predispose to AF by increasing left atrial size or impairing left ventricular diastolic function in hypertrophic cardiomyopathy [10]; its role in predicting new-onset POAF after septal myectomy in these patients has not been well investigated
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