The predictive role of renal function and systemic inflammation on the onset of de novo atrial fibrillation after cardiac surgery

Limite, Luca Rosario; Magnoni, Marco; Berteotti, Martina; Peretto, Giovanni; Durante, Alessandro; Cristell, Nicole; Laricchia, Alessandra; Camici, Paolo G.; Alfieri, Ottavio; Cianflone, Domenico

doi:10.1177/2047487314564896

Cited by 14 publications

(17 citation statements)

References 26 publications

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“…First, the meta-analysis was based on data from study level rather than individual patient data. Accordingly, influences of a few key characteristics on the possible preventative role of Dex for POAF could not be analyzed in our meta-analysis, such as left atrial volume ( 44 ), renal function ( 45 ), and concurrent cardiovascular medications including perioperative use of beta-blockers, amiodarone, and electrolyte replacement protocol for K and Mg etc. ( 46 ), which have all been suggested to affect the risk of POAF after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Peng

Juan

et al. 2021

Front. Cardiovasc. Med.

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Background: Previous clinical studies and meta-analysis evaluating the influence of dexmedetomidine on postoperative atrial fibrillation showed inconsistent results. We performed an updated meta-analysis to evaluate the influence of dexmedetomidine on incidence of postoperative atrial fibrillation after cardiac surgery.Methods: Randomized controlled trials that evaluated the potential influence of dexmedetomidine on the incidence of atrial fibrillation after cardiac surgery were obtained by search of PubMed, Embase, and Cochrane's Library databases from inception to April 12, 2021. A random-effects model incorporating the potential publication bias was used to pool the results. Influences of patient or study characteristics on the efficacy of dexmedetomidine on atrial fibrillation after cardiac surgery were evaluated by meta-regression and subgroup analyses.Results: Fifteen studies with 2,733 patients were included. Pooled results showed that dexmedetomidine significantly reduced the incidence of atrial fibrillation compared to control (OR: 0.72, 95% CI: 0.55–0.94, p = 0.02) with mild heterogeneity (I2 = 26%). Subgroup analysis showed that dexmedetomidine significantly reduced the incidence of atrial fibrillation in studies from Asian countries (OR: 0.41, 95% CI: 0.26–0.66, p < 0.001), but not in those from non-Asian countries (OR: 0.89, 95% CI: 0.71–1.10, p = 0.27; p for subgroup difference = 0.004). Meta-regression analysis showed that the mean age and proportion of male patients may modify the influence of dexmedetomidine on POAF (coefficient = 0.028 and 0.021, respectively, both p < 0.05). Subgroup analysis further showed that Dex was associated with reduced risk of atrial fibrillation after cardiac surgery in studies with younger patients (mean age ≤ 61 years, OR = 0.44, 95% CI: 0.28–0.69, p = 0.004) and smaller proportion of males (≤74%, OR = 0.55, 95% CI: 0.36–0.83, p = 0.005), but not in studies with older patients or larger proportion of males (p for subgroup difference = 0.02 and 0.04).Conclusions: Current evidence supports that perioperative administration of dexmedetomidine may reduce the risk of incidental atrial fibrillation after cardiac surgery, particularly in Asians.

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Section: Discussionmentioning

confidence: 99%

Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Peng

Juan

et al. 2021

Front. Cardiovasc. Med.

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“…22,23 Recent studies have shown that CKD, even of a mild degree, is associated with the development of AF independent of traditional risk factors. 3–7 However, the underlying pathophysiological mechanisms of this association have not been fully elucidated. We found that CKD was significantly associated with impaired LA reservoir function in a general population without overt cardiac disease.…”

Section: Discussionmentioning

confidence: 99%

“…Chronic kidney disease (CKD) is a global health concern 1,2 and is recognized as an independent risk factor for the development of atrial fibrillation (AF). 3–7 However, the underlying mechanisms for the higher incidence of AF in patients with CKD are not yet fully elucidated. Although left atrial (LA) enlargement is an established marker for the development of AF, recent studies have reported that impaired LA reservoir function preceded LA enlargement 8,9 and was strongly associated with the development of AF, independent of LA volume and left ventricular (LV) function.…”

Section: Introductionmentioning

confidence: 99%

Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study

Nakanishi

Jin

Russo

et al. 2016

Eur J Prev Cardiolog

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Background Chronic kidney disease (CKD) is an independent risk factor for atrial fibrillation, although the pathophysiological mechanisms remain unclear. This study investigated the relationship between CKD and left atrial (LA) volume and function in a sample of the general population without overt cardiac disease. Design and methods We examined 358 participants from the Cardiovascular Abnormalities and Brain Lesions study. The LA minimum volume index (LAVI), LA maximum volume index (LAVI), and LA emptying fraction (LAEF) were assessed by real-time three-dimensional echocardiography. Based on their estimated glomerular filtration rate (eGFR), the participants were divided into a CKD group (eGFR <60 ml/min/1.73 m) and a non-CKD group (eGFR ≥60 ml/min/1.73 m). Results Of the 358 participants, 69 (19%) were classified as having CKD and 289 (81%) as non-CKD. Participants with CKD were older, had a greater prevalence of hypertension and use of antihypertensive drugs, a larger left ventricular (LV) mass index, and a higher prevalence of diastolic dysfunction than those without CKD (all p < 0.05). There was no significant difference in LAVI between the CKD and non-CKD groups (23.4 ± 7.1 vs. 22.8 ± 5.8 ml/m, p = 0.47), whereas significant differences were observed for LAVI (13.6 ± 5.5 vs. 12.0 ± 4.6 ml/m, p = 0.01) and LAEF (42.7 ± 11.4 vs. 47.8 ± 11.5%, p = 0.001). Multivariate regression analysis revealed that the eGFR was significantly associated with LAEF independent of age, LV mass index, and diastolic dysfunction (all p < 0.05). Conclusions Participants with CKD in an unselected community-based cohort had significantly impaired LA reservoir function. Assessment of LA function may add important information in the prognostic assessment of patients with CKD even in the absence of overt cardiac disease.

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“…C-reactive protein) have been reported in early stages of CKD, and inflammation plays a significant role in the pathogenesis of AF. 13,14 Neurohormonal activation has also been implicated in the pathogenesis of renal dysfunction and AF, with the activation of the renin-angiotension-aldosterone system 15,16 and the sympathetic pathway 17 in both pathologies. Structural cardiac abnormalities, such as cardiac fibrosis, 18 and increased left atrium and left ventricular hypertrophy, 19 also play a role in CKD and incident AF.…”

Section: Discussionmentioning

confidence: 99%

Estimated glomerular filtration rate within the normal or mildly impaired range and incident non-valvular atrial fibrillation: Results from a population-based cohort study

Eisen

Haim

Hoshen

et al. 2016

Eur J Prev Cardiolog

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Background Lower estimated glomerular filtration rate, in particular in the significant renal impairment range (estimated glomerular filtration rate <60 ml/min/1.73 m), is associated with incident atrial fibrillation. This association is less established within the normal or mildly impaired estimated glomerular filtration rate range. Methods Using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate formula, we identified ambulatory adults (>22 years old) without rheumatic heart disease or prosthetic valves and with 60 ml/min/1.73 m10 m patient-years of follow-up (∼75% <60 years old, ∼57% females), >65,000 individuals had ≥1 atrial fibrillation event (incident atrial fibrillation rate 5.1% and 5.8% excluding or including prior cardiovascular disease, or 49 and 55 per 10,000 patient-years, respectively). In both cohorts, individuals with versus without incident atrial fibrillation had lower mean estimated glomerular filtration rate (∼83 versus 95 ml/min/1.73 m). Adjusting for age, gender, hypertension, and diabetes mellitus, overall a 10 ml/min/1.73 m decrease in estimated glomerular filtration rate was independently associated with a mean increase in incident atrial fibrillation of 1.5% and 2.4% in the cohorts excluding or including prior cardiovascular disease, respectively ( p < 0.001 for both). However, a graded association between lower estimated glomerular filtration rate and atrial fibrillation was observed in the 90-130 ml/min/1.73 m range, whereas a blunted association was observed in the 60-90 ml/min/1.73 m range. Conclusion Within the 60 ml/min/1.73 m< estimated glomerular filtration rate < 130 ml/min/1.73 m range, lower estimated glomerular filtration rate is independently associated with incident non-valvular atrial fibrillation in adults without prior atrial fibrillation, mainly attributed to a graded association within the 90-130 ml/min/1.73 m range.

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The predictive role of renal function and systemic inflammation on the onset of de novo atrial fibrillation after cardiac surgery

Abstract: Age and eGFR were identified as the strongest predictors of POAF in a population largely composed of valve surgery patients. Renal function, even from early stage, is independently associated with the increasing risk of developing POAF.

Cited by 14 publications

References 26 publications

Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Influence of Dexmedetomidine on Post-operative Atrial Fibrillation After Cardiac Surgery: A Meta-Analysis of Randomized Controlled Trials

Association of chronic kidney disease with impaired left atrial reservoir function: A community-based cohort study

Estimated glomerular filtration rate within the normal or mildly impaired range and incident non-valvular atrial fibrillation: Results from a population-based cohort study

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