Atrium; Fibrillation Clinical Trial
Official title:
Relationship Between Echocardiographic Left Atrial Function Assessment and Atrial Fibrillation Post-Coronary Artery Bypass Surgery
The aim of this study to investigate the correlation between preoperative LA function using
2D echocardiography and left atrium 2D speckle tracking strain echocardiography and the
development of Post Operative AF after CABG.
the investigators chose electrocardiography as a reference standard for detection of Post
Operative AF. LA dysfunction is diagnosed with Echocardiography
Atrial fibrillation (AF) is one of the most common postoperative complications following
cardiac surgery. This in turn translates into longer hospitalization, increased cost of
hospitalization as well as association with thromboembolic events and mortality .
Despite new-onset postoperative atrial fibrillation (NoPOAF) occurring in 20-40% of patients
following coronary artery bypass graft (CABG) surgery, the underlying mechanisms are not well
established. However, it has been traditionally thought to be transient and benign to the
patient.
Recent evidence suggests that POAF may be more 'malignant' than previously thought,
associated with follow-up mortality and morbidity.
Previously, increased left atrial (LA) size and LA dysfunction have been shown to be related
to the subsequent development of atrial fibrillation (AF), stroke, myocardial infarction, and
heart failure.
Also, recent studies suggest that LA dysfunction caused by the effects of oxidative stress,
inflammation, and atrial fibrosis, has a role. In other words, by acute functional
depression, preoperative LA dysfunction may be the starting point of the development of POAF
after coronary artery bypass grafting (CABG).(8) Therefore, as the improvement in the
evaluation of LA function, preoperative LA dysfunction may emerge as an important component
in the identification of patients with the risk of POAF after CABG surgery.
Echocardiography is the most common diagnostic method for assessing atrial function but the
technique has some limitations. Traditionally, assessment of left atrial function has been
performed by measuring volumes with 2D echocardiography. Additionally, it can be assessed
with transmitral Doppler and pulmonary vein Doppler. Recently, an alternative method has been
incorporated, namely, measurement of myocardial deformation with color tissue Doppler-derived
strain.
However, this method has several limitations, such as suboptimal reproducibility,
angle-dependence, signal artifacts and the fact that it only measures regional strain and
does not obtain information about the curved portion of the atrial roof. To overcome these
limitations in the quantification of atrial function, the use of speckle tracking
echocardiography (STE) strain has been proposed. This technique is not derived from Doppler
but rather from 2D echocardiography, it is angle-independent, and allows us to measure global
as well as regional atrial strain. STE is a new technique of 2D echocardiography image
analysis that allows the study of regional atrial myocardial deformation expressed by a
dimensionless parameter.
2-dimensional (2D) speckle tracking strain imaging is a feasible and reproducible technique
for the assessment of LA function by evaluating LA deformation dynamics.
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