Pre-Operative Reduced Atrial Compliance Is Predictive of Post-Operative Atrial Fibrillation in Patients Undergoing Esophagectomy

IF 1.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2025-09-11 DOI:10.1111/echo.70298

Michal Schäfer, Brian Mitzman, Courtney L. Scaife, Jessica Magarinos, Satvik Ramakrishna, Ethan Tumarkin, Bryce Hill, Thomas K. Varghese Jr, Nicolas Contreras

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引用次数: 0

Abstract

Background

There are no established predictors of postoperative atrial fibrillation (POAF) in patients undergoing esophagectomy. This study aimed to determine whether pre-operative bi-atrial strain might predict POAF in patients undergoing esophageal resection.

Methods

Patients who underwent esophagectomy and had preoperative echocardiography underwent comprehensive myocardial strain analysis measuring left and right atrial (LA and RA) phase-specific strain and left and right global longitudinal strain (LV and RV GLS). Clinical and traditional variables were sampled and considered for multivariable models with the POAF serving as a primary outcome of the study.

Results

Fifty-nine patients constituted the study group and the incidence of POAF was 25.4% (N = 15). Patients who developed POAF were older and had a higher rate of anastomotic leak. LA strain analysis was overall suggestive of reduced LA compliance in the POAF group with decreased LA reservoir strain (33.9 ± 8.9 vs. 22.0 ± 8.8%, p < 0.001) and LA conduit strain (−18.4 ± 9.2 vs. −9.6 ± 5.5%, p < 0.001). RA reservoir strain was also reduced in the POAF group (36.9 ± 8 vs. 29.6 ± 8.1%, p = 0.006) together with reduced RA conduit strain (−20.6 ± 6.9 vs. −15.4 ± 7.6%, p = 0.042). LV GLS was decreased in patients with POAF (−16.2 ± 3.5 vs. −12.3 ± 7.5%, p = 0.036), along with RV GLS (−17.6 ± 3.4 vs. −14.4 ± 3.8%, p = 0.009). Reduced LA reservoir strain remained an independent predictor for POAF when combined with the presence of an anastomotic leak [OR: 0.85 (95% CI: 0.75–0.92), p < 0.001] yielding model with AUC of 0.86 with a sensitivity 60.0% and specificity 90.1%.

Conclusion

Reduced bi-atrial compliance evidenced by standard echocardiographic strain analysis predicts POAF in patients undergoing esophagectomy. Comprehensive echocardiographic evaluation should be considered in surgical candidates before esophageal surgery, given the detected subclinical global myocardial dysfunction.

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食管切除术患者术前心房顺应性降低可预测术后心房颤动。

背景：食管切除术患者术后心房颤动（POAF）尚无确定的预测因素。本研究旨在确定术前双心房应变是否可以预测食管切除术患者的POAF。方法：对行食管切除术并行术前超声心动图检查的患者进行全面的心肌应变分析，测量左、右心房（LA、RA）相特异性应变和左、右总纵向应变（LV、RV GLS）。对临床变量和传统变量进行采样，并考虑多变量模型，以POAF作为研究的主要结果。结果：研究组59例，POAF发生率为25.4% （N = 15）。发生POAF的患者年龄较大，吻合口瘘发生率较高。LA应变分析总体上提示POAF组LA依从性降低，LA库应变降低（33.9±8.9 vs. 22.0±8.8%）。结论：标准超声心动图应变分析证明双房依从性降低可预测食管切除术患者的POAF。考虑到检测到亚临床全身性心肌功能障碍，在食管手术前应考虑对手术候选人进行全面的超声心动图评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.