Evaluation of left atrial strain using speckle-tracking echocardiography to predict postoperative atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis

Abstract

Aim. To conduct a systematic review and meta-analysis to investigate the prognostic role of left atrial (LA) strain assessment using speckle-tracking echocardiography to predict postoperative atrial fibrillation (POAF) in patients undergoing coronary bypass grafting (CABG).Material and methods. We searched the PubMed (Medline) and Google Scholar databases for studies investigating LA strain measures obtained by speckle tracking echocardiography as predictors of POAF in patients after CABG. To determine the difference in the weighted average LA strain parameters, an analysis was made of the global LA strain, peak atrial longitudinal strain (PALS), left atrial conduit strain (LACS) and left atrial contractile strain (LACtS). Odds ratio (OR) values were received from multivariate models reporting association between PALS and POAF and described as pooled estimates with 95% confidence intervals (CI).Results. Twelve studies from 404 publications were selected for this systematic review and meta-analysis. A total of 1093 patients were included in the analysis, with a mean age of 60,5 years. A meta-analysis showed that patients with POAF had lower global LA strain than patients without POAF (difference in weighted values, 5,03%; 95% CI: -6,89 to -3,16; p<0,001). In addition, patients with POAF had lower PALS, LACS and LACtS; the difference in weighted values was 9,90% (95% CI: -12,95 to -6,85; p<0,001), 4,17% (95% CI: -6,05 to -2,29; p<0,001) and 6,1 7% (95% CI: -12,01 to -0,33; p=0,04), respectively. Moreover, in a pooled odds ratio (OR) analysis, PALS was found to be an independent predictor of POAF (OR: 0,88 for every 1% increase in PALS; 95% CI: 0,82–0,94; p<0,0001).Conclusion. Assessment of LA strain using speckle-tracking echocardiography provides important additional information for predicting POAF in patients undergoing isolated CABG.