Preoperative Echocardiographic Indices of Diastolic Dysfunction and Brain Natriuretic Peptide in Predicting Postoperative Atrial Fibrillation After Noncardiac Surgery

Abstract

In a cohort of patients who had echocardiography and BNP measurements before undergoing major thoracic surgery, this study showed that when evaluated together greater preoperative left atrial diastolic volume index and transmitral flow deceleration time but not BNP levels were independent predictors for POAF.

A brain natriuretic peptide-based prediction model for atrial fibrillation after thoracic surgery: Development and internal validation

“…9,10,12 When we directly compared BNP level to echocardiography-derived parameters to predict POAF in a similar population of patients, indices of left atrial and diastolic dysfunction, but not BNP level, were independently associated with greater risk of POAF. 7 However, in that study, elevations in preoperative BNP level were correlated with older age and increased left atrial size and diastolic dysfunction among patients who mostly had no evidence of clinically significant cardiac dysfunction. 7 Traditionally, elevated atrial natriuretic peptide levels have been demonstrated in patients with heart failure and either ventricular or atrial wall distension.…”

“…7 However, in that study, elevations in preoperative BNP level were correlated with older age and increased left atrial size and diastolic dysfunction among patients who mostly had no evidence of clinically significant cardiac dysfunction. 7 Traditionally, elevated atrial natriuretic peptide levels have been demonstrated in patients with heart failure and either ventricular or atrial wall distension. BNP level may also increase with chronic conditions, such as aging, atrial fibrosis, and inflammation-factors that are also known to contribute to the occurrence of POAF in patients without clinical evidence of cardiac wall stretch or heart failure.…”

“…2,4 We and others have recently shown that preoperative echocardiographic indices of atrial enlargement and diastolic dysfunction are associated with risk of POAF after thoracic surgery. [5][6][7] Echocardiography, however, is not performed routinely before thoracic surgery, and, if it is performed, the special measurements needed to detect these factors require significant expertise and additional costs. By comparison, blood biomarkers are easy to analyze.…”

<p>Predictors of Postoperative Atrial Fibrillation After Abdominal Surgery and Insights from Other Surgery Types</p>

“…A recent study performed in patients undergoing non-cardiac thoracic surgery demonstrated that increased LA volume index, reduced LA emptying fraction, and transmitral flow deceleration time were predictive of POAF. 38,39 Several prospective and retrospective studies have reported that a larger preoperative LA is associated with POAF after both cardiac valve surgery and CABG. [40][41][42][43][44][45][46][47] More advanced TTE measurements, such as speckletracking and strain analysis of the LA, have recently been investigated in numerous cardiac surgical populations.…”

Evaluation of Cardiac-Vascular Complications Risk in Out-of-Cardiac Surgery: Comorbidity and Use of Clinical Evaluation Scale

“…Однако понимание предсто-ящего объема оперативного вмешательства и достаточно Практическая медицина Problems of practical health care предоперационная ЭхоКГ не была связана с улучшением послеоперационных результатов [36]. Предоперационные уровни натрийуретических пептидов сильно коррелируют с прогнозом ХСН, послеоперационной смертностью и ос-ложненностью [37,38]. По сравнению с единичным опреде-лением пептидов, серийное улучшает риск-стратификацию по композитным точкам (смерть, нефатальный ИМ) [39].…”