The relationship between left atrial volume and mechanical functions evaluated using 3-dimensional echocardiography prior to coronary artery by-pass surgery and the relationship between NT-proANP level and postoperative new onset of atrial fibrillation

The Relationship Between Left Atrial Volume And Mechanical Functions Evaluated Using 3-Dimensional Echocardiography Prior To Coronary Artery By-Pass Surgery And The Relationship Between NT-proANP Level And Postoperative New Onset Of Atrial fibrillation. Introduction and Objective Postoperative AF (POAF) is the most common cause of morbidity after coronary artery bypass surgery. Increased left atrial size and left atrial dysfunction are associated with the development of atrial fibrillation in the future. In this study, we aimed to show the relationship between POAF and NT-proANP levels and the relationship between mechanical functions and left atrial volume measured using preoperative 3D-ECHO among patients that will undergo isolated CABS in elective conditions. Material and Methods 66 consecutive patients (51 male, 15 female) who were decided to undergo CABS and had normal sinus rhythm were involved in the study. All individuals who participated in the study, clinical, angiographic and demographic characteristics were recorded in a detailed manner. LA volume and mechanical functions consisting of LA largest volume (Vmax ) , LA smallest volume ( Vmin) , LA volume prior to contraction ( vpreA ), LA active stroke volume ( ASV ), LA total stroke volume ( TSV) , LA active emptying fraction ( AEF) , LA total emptying fraction ( TEF) , LA passive emptying fraction ( PEF) , LA expansion index (EI) and LA volume index (LAVİ) were calculated with 3D ECHO. In addition, for the analysis of plasma levels of NT-proANP, blood samples were collected 1 hour before the surgery and sent to the laboratory. Results During follow-up after the operation, 15 patients (22.7 %) had postoperative atrial fibrillation. Although the mean age of patients in sinus rhythm was 58.2 ± 8.3 years, the mean age of the group that developed AF was 71.6 ± 6.23 years (p < 0.001). For the group that developed AF after surgery, total cardiopulmonary bypass time (81.75 ± 18.83 versus 93.43 ± 13.79 min, p < 0.05) was longer. After the operation, length of hospital stay was longer in the group that developed AF (8.6 ± 0.97 days versus 7.45 ± 1.12 days, p < 0.001). When LA volume and mechanical function were examined through 3D ECHO, LA Vmax , Vmin , VpreA values were higher in POAF group and the difference between two groups was statistically significant (p <0.001 , p = 0.004 , p < 0.001 respectively). EI, TEF and PEF percent compared with SR group, the group that developed POAF were lower as statistically significant (p < 0.001). ASV values were significantly higher in the group developed POAF (p < 0.001). In terms of TSV value and AEF percentage no statistically significant difference (p> 0.05) was found between the two groups. Also in POAF developed group and SR group, LAVI values were 27.56 ± 4.2 and 20.7 ± 4.64 ml/m2 respectively. POAF group LAVI values were significantly higher compared to the SR group and this difference between groups was statistically significant (p < 0.001). In POAF group and SR group, NT-proANP values were 592.24 ± 167.03 ( pg / ml) and 365.17 ± 149.83 ( pg / mL ), respectively . In POAF developing group, NT-proANP levels were significantly higher compared to the SR group and this difference between groups was statistically significant (p < 0.001). When NT-proANP to Vmax and Vmin relationship were examined, positive correlation (r = 0.673, r = 0.698 , respectively ) was observed. When the multivariate logistic regression analysis carried out, age and LA volume index was found to be an independent predictor (p values of 0.007 and 0.012 respectively) in POAF development. Conclusion It was found that 3D echocardiography can be used as a helping noninvasive method to show subclinical atrial volume and mechanical dysfunction in patients undergoing CABS. When POAF developing group was compared to SR group, it was also found that left atrial volume level was increased and mechanical functions were corrupted. Also blood levels of NT-proANP in POAF group were increased and NT - proANP levels, LA volume and mechanical functions were related to each other.