Pre-Operative Atrial Deformation Indices Predict Post-Operative Atrial Fibrillation in Patients Undergoing Lung Resection Surgery

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-02-14 DOI:10.1111/echo.70105

Michal Schäfer, Nicolas Contreras, Satvik Ramakrishna, Joshua M. Zimmerman, Thomas K. Varghese Jr, Brian Mitzman

{"title":"Pre-Operative Atrial Deformation Indices Predict Post-Operative Atrial Fibrillation in Patients Undergoing Lung Resection Surgery","authors":"Michal Schäfer, Nicolas Contreras, Satvik Ramakrishna, Joshua M. Zimmerman, Thomas K. Varghese Jr, Brian Mitzman","doi":"10.1111/echo.70105","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>There are no established predictors of post-operative atrial fibrillation (POAF) in non-cardiac thoracic surgery. Pre-operative left atrial imaging has been shown to identify patients with POAF undergoing cardiac surgery. The purpose of this study was to determine whether pre-operative left atrial strain (LAS) predicts POAF in patients undergoing lung resection.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>One hundred forty-nine patients who underwent cancer lung resection were retrospectively analyzed. Pre-operative imaging involved conventional transthoracic echocardiography with comprehensive speckle-tracking strain. The additional advanced LAS analysis involved three components of atrial function: reservoir, conduit, and booster.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>POAF occurred in 17 (11.4%) patients. We found no differences in demographics and peri-operative variables. Patients with POAF were more likely to have atrial fibrillation history (6.8% vs. 29.4%, <i>p</i> = 0.003). Preoperative imaging analysis revealed an increased LA volume index in patients with POAF (25.9 ± 8.8 vs. 32.3 ± 11.9 mL/m<sup>2</sup>, <i>p</i> = 0.046). All three components of LAS were reduced in the POAF group. The most prominent reduction was reservoir–compliance strain (35.5% ± 4.6% vs. 24.2% ± 6.6%, <i>p</i> < 0.001), then conduit strain (–18.3% ± 8.7% vs. –12.6% ± 4.7%, <i>p</i> < 0.001), and booster strain (–18.3% ± 8.7% vs. –12.6% ± 4.7%, <i>p</i> < 0.001). On univariable analysis, LAS reservoir strain was associated with POAF status (OR: 0.86 [95% CI: 0.78–0.92]), with a c-index of 0.81. Optimized multivariable model considering left atrial volume index, reservoir LAS, and atrial fibrillation history improved c-statistic to 0.880.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Reduced LAS metrics are more specific and sensitive than conventional demographics and standard echocardiography in predicting POAF. Preoperative LA imaging might aid with identifying patients undergoing lung resection who are high-risk and benefit from prophylactic therapy.</p>\n </section>\n </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 2","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/echo.70105","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

There are no established predictors of post-operative atrial fibrillation (POAF) in non-cardiac thoracic surgery. Pre-operative left atrial imaging has been shown to identify patients with POAF undergoing cardiac surgery. The purpose of this study was to determine whether pre-operative left atrial strain (LAS) predicts POAF in patients undergoing lung resection.

Methods

One hundred forty-nine patients who underwent cancer lung resection were retrospectively analyzed. Pre-operative imaging involved conventional transthoracic echocardiography with comprehensive speckle-tracking strain. The additional advanced LAS analysis involved three components of atrial function: reservoir, conduit, and booster.

Results

POAF occurred in 17 (11.4%) patients. We found no differences in demographics and peri-operative variables. Patients with POAF were more likely to have atrial fibrillation history (6.8% vs. 29.4%, p = 0.003). Preoperative imaging analysis revealed an increased LA volume index in patients with POAF (25.9 ± 8.8 vs. 32.3 ± 11.9 mL/m², p = 0.046). All three components of LAS were reduced in the POAF group. The most prominent reduction was reservoir–compliance strain (35.5% ± 4.6% vs. 24.2% ± 6.6%, p < 0.001), then conduit strain (–18.3% ± 8.7% vs. –12.6% ± 4.7%, p < 0.001), and booster strain (–18.3% ± 8.7% vs. –12.6% ± 4.7%, p < 0.001). On univariable analysis, LAS reservoir strain was associated with POAF status (OR: 0.86 [95% CI: 0.78–0.92]), with a c-index of 0.81. Optimized multivariable model considering left atrial volume index, reservoir LAS, and atrial fibrillation history improved c-statistic to 0.880.

Conclusion

Reduced LAS metrics are more specific and sensitive than conventional demographics and standard echocardiography in predicting POAF. Preoperative LA imaging might aid with identifying patients undergoing lung resection who are high-risk and benefit from prophylactic therapy.

查看原文本刊更多论文

术前心房变形指标预测肺切除术患者术后心房颤动

背景非心脏胸外科术后房颤（POAF）尚无确定的预测因素。术前左心房成像已被证明可以识别接受心脏手术的POAF患者。本研究的目的是确定术前左心房应变（LAS）是否能预测肺切除术患者的POAF。方法对149例肺癌肺切除术患者进行回顾性分析。术前影像学包括常规经胸超声心动图综合斑点追踪应变。额外的高级LAS分析涉及心房功能的三个组成部分：储血池、导管和助推器。结果17例（11.4%）患者发生POAF。我们没有发现人口统计学和围手术期变量的差异。POAF患者有房颤史的可能性更大（6.8% vs 29.4%, p = 0.003）。术前影像学分析显示，POAF患者LA容积指数升高（25.9±8.8 vs. 32.3±11.9 mL/m2, p = 0.046）。POAF组LAS的三个组成部分均降低。降幅最显著的是储层顺应性菌株（35.5%±4.6% vs. 24.2%±6.6%），p <；0.001),然后管道应变(-18.3%±8.7%比-12.6%±4.7%,p & lt;0.001)和增压压力(-18.3%±8.7%比-12.6%±4.7%,p & lt;0.001)。在单变量分析中，LAS水库菌株与POAF状态相关（OR: 0.86 [95% CI: 0.78-0.92]）， c指数为0.81。考虑左房容积指数、储层LAS和房颤病史的优化多变量模型将c统计量提高到0.880。结论降低的LAS指标在预测POAF方面比常规人口统计学指标和标准超声心动图指标更具特异性和敏感性。术前LA成像可能有助于识别接受肺切除术的高危患者，并从预防性治疗中获益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.