Utility of Brain Natriuretic Peptide as a Predictor of Atrial Fibrillation After Cardiac Operations

Circulating cardiac biomarkers and postoperative atrial fibrillation in the OPERA trial

“…The lack of independent predictive value of perioperative cardiac biomarkers for POAF may be the consequence of the complex interplay between pre‐existing conditions and surgical stress in triggering POAF. These findings are consistent with those previously published by others , both in cardiac and noncardiac surgery. The involvement of other responses such as inflammatory activation reported in on‐pump cardiac surgery may also offer other predictive markers in this setting.…”

“…Some have assayed biomarkers before and after surgery with little added predictive value when postsurgery values were used. Overall, evidence in support of the independent predictive value of natriuretic peptides comes from all the studies above, except one . However, a recent study in 3148 patients undergoing CABG showed no independent predictive value of preoperative cardiac troponin I for POAF .…”

“…Whether circulating biomarkers of inflammation prior to surgery improve prediction of POAF remains unclear [6][7][8][9]. Several monocentric studies of 80-400 patients have evaluated perioperative levels of natriuretic peptides [10][11][12][13][14] and cardiac troponins [15] with respect to AF following cardiac surgery. Some have assayed biomarkers before and after surgery [14,15] with little added predictive value when postsurgery values were used.…”

Left-ventricular electromechanical delay is prolonged in patients with postoperative atrial fibrillation

“…Standard transthoracic echocardiography and tissue Doppler imaging were performed on each subject in the partial left decubitus position by a Sonos 5500 ultrasound system (Philips Medical Systems, Andover, Massachusetts, USA) with a 3S transducer (3)(4)(5). The pulsed Doppler of the left-ventricular inflow was assessed in the apical fourchamber view, and the sample volume was placed at the mitral tip level.…”

“…Postoperative AF is associated not only with mortality but also with the incidence of stroke and the length of hospital stay and places substantial financial and clinical burdens on clinicians and patients. While several preoperative risk factors have been proposed for AF, including older age, decreased cardiac function [4], large atrial size, and a high brain natriuretic peptide (BNP) level [5], the occurrence rate of postoperative AF is reported to be between 10% and 26%, even in low-risk patients [6,7]. The contributing factors for postoperative AF in those cases remain unclear.…”