Risk factors and predictive value of estimated glomerular filtration rate for new-onset atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy after modified extended Morrow procedure_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MENG Yanhai ¹ , LIU Ping ¹ , ZHANG Yanbo ¹ , WANG Shengwei ² , ZHU Changsheng ² , CHANG Shuo ¹ , QI Qi ¹ , HU Enci ¹ , LI Liang ¹ , LIU Zina ¹ ,  WANG Shuiyun ²

1. Adult Surgery ICU, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;
2. Adult Surgery Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, P.R.China;

Corresponding author：

WANG Shuiyun, Email: wsymd@sina.com

Keywords：

Hypertrophic obstructive cardiomyopathy; estimated glomerular filtration rate; atrial fibrillation; perioperative period; risk factors

DOI：

10.7507/1007-4848.202007098

Video：

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Objective To explore the association between preoperative, perioperative parameters, especially estimated glomerular filtration rate (eGFR) and postoperative atrial fibrillation (POAF) after modified extended Morrow procedure.Methods A total of 300 hypertrophic obstructive cardiomyopathy (HOCM) patients who underwent modified extended Morrow procedure in our hospital from January 2012 to March 2018 were collected. There were 197 (65.67%) males and 103 (34.33%) females with an average age of 43.54±13.81 years. Heart rhythm was continuously monitored during hospitalization. The patients were divided into a POAF group (n=68) and a non-POAF group (n=232). The general data, perioperative parameters and echocardiographic results were collected by consulting medical records for statistical analysis. Univariate and multivariate logistic regression models were used to analyze the risk factors for POAF.Results Overall incidence of POAF during hospitalization was 22.67% (68/300). Compared with patients without POAF, patients with POAF were older, had higher incidence of chest pain and syncope, lower level of preoperative eGFR, higher body mass index and heart function classification (NYHA), larger preoperative left atrial diameter and left ventricular end diastolic diameter, and longer ventilator-assisted time, ICU stay and postoperative hospital stay. Age, heart function classification (NYHA)≥Ⅲ, hypertension, syncope history and eGFR were independent risk factors for POAF. Receiver operating characteristic curve analysis showed that the area under the curve of eGFR was 0.731 (95%CI 0.677-0.780, P<0.001), and the sensitivity and specificity were 82.4% and 57.8%, respectively.Conclusion Increased age, high preoperative heart function classification (NYHA), hypertension, preoperative syncope history and decreased eGFR are independent risk factors for POAF in HOCM patients who underwent surgical septal myectomy. Preoperative decreased eGFR can moderately predict the occurrence of POAF after modified extended Morrow procedure.

Citation： MENG Yanhai, LIU Ping, ZHANG Yanbo, WANG Shengwei, ZHU Changsheng, CHANG Shuo, QI Qi, HU Enci, LI Liang, LIU Zina, WANG Shuiyun. Risk factors and predictive value of estimated glomerular filtration rate for new-onset atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy after modified extended Morrow procedure. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(10): 1234-1241. doi: 10.7507/1007-4848.202007098 Copy

1.	Rezaei Y, Peighambari MM, Naghshbandi S, et al. Postoperative atrial fibrillation following cardiac surgery: From pathogenesis to potential therapies. Am J Cardiovasc Drugs, 2020, 20(1): 19-49.
2.	Axtell AL, Moonsamy P, Melnitchouk S, et al. Preoperative predictors of new-onset prolonged atrial fibrillation after surgical aortic valve replacement. J Thorac Cardiovasc Surg, 2020, 159(4): 1407-1414.
3.	Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
4.	Garg L, Gupta M, Sabzwari SRA, et al. Atrial fibrillation in hypertrophic cardiomyopathy: Prevalence, clinical impact, and management. Heart Fail Rev, 2019, 24(2): 189-197.
5.	Tang B, Song Y, Cui H, et al. Prediction of mid-term outcomes in adult obstructive hypertrophic cardiomyopathy after surgical ventricular septum myectomy. J Am Coll Cardiol, 2017, 70(16): 2092-2094.
6.	Watanabe H, Watanabe T, Sasaki S, et al. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: The Niigata preventive medicine study. Am Heart J, 2009, 158(4): 629-636.
7.	Massicotte-Azarniouch D, Kuwornu JP, Carrero JJ, et al. Incident atrial fibrillation and the risk of congestive heart failure, myocardial infarction, end-stage kidney disease, and mortality among patients with a decreased estimated GFR. Am J Kidney Dis, 2018, 71(2): 191-199.
8.	Chua SK, Shyu KG, Lu MJ, et al. Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: Role beyond the CHA2DS2-VASc score. Europace, 2015, 17(9): 1363-1370.
9.	申志祥, 刘宇, 刘敏, 等. 基于肌酐与胱抑素的肾小球滤过率估算方程对人群肾功能分期的评价及应用. 中华流行病学杂志, 2017, 38(11): 1557-1562.
10.	Wang S, Cui H, Yu Q, et al. Excision of anomalous muscle bundles as an important addition to extended septal myectomy for treatment of left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg, 2016, 152(2): 461-468.
11.	Yamashita K, Hu N, Ranjan R, et al. Clinical risk factors for postoperative atrial fibrillation among patients after cardiac surgery. Thorac Cardiovasc Surg, 2019, 67(2): 107-116.
12.	Filardo G, Damiano RJ, Ailawadi G, et al. Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery. Heart, 2018, 104(12): 985-992.
13.	Guo Y, Wu X, Zheng X, et al. Usefulness of preoperative transforming growth factor-beta to predict new onset atrial fibrillation after surgical ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy. Am J Cardiol, 2017, 120(1): 118-123.
14.	Song C, Wang S, Guo Y et al. Plasma big endothelin-1 predicts new-onset atrial fibrillation after surgical septal myectomy in patients with hypertrophic cardiomyopathy. BMC Cardiovasc Disord, 2019, 19(1): 122.
15.	Kinoshita T, Asai T, Ishigaki T, et al. Preoperative heart rate variability predicts atrial fibrillation after coronary bypass grafting. Ann Thorac Surg, 2011, 91(4): 1176-1181.
16.	Ismail MF, El-Mahrouk AF, Hamouda TH et al. Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience. J Cardiothorac Surg, 2017, 12(1): 40.
17.	Nguyen A, Schaff HV, Sedeek AF, et al. Septal myectomy and concomitant coronary artery bypass grafting for patients with hypertrophic cardiomyopathy and coronary artery disease. Mayo Clin Proc, 2020, 95(3): 521-525.
18.	李延培, 屈正, 刘晓峥, 等. 非体外冠脉搭桥术后新发房颤的相关危险因素分析. 中国心血管病研究, 2015, 13(3): 275-278.
19.	Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: A meta-analysis. Europace, 2018, 20(1): 33-42.
20.	Lee JS, Shim CY, Wi J, et al. Left ventricular diastolic function is closely associated with mechanical function of the left atrium in patients with paroxysmal atrial fibrillation. Circ J, 2013, 77(3): 697-704.
21.	Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet, 2013, 381(9862): 242-255.
22.	Almassi GH, Pecsi SA, Collins JF, et al. Predictors and impact of postoperative atrial fibrillation on patients' outcomes: A report from the randomized on versus off bypass trial. J Thorac Cardiovasc Surg, 2012, 143(1): 93-102.
23.	Hashemzadeh K, Dehdilani M, Dehdilani M. Does off-pump coronary artery bypass reduce the prevalence of atrial fibrillation? J Cardiovasc Thorac Res, 2013, 5(2): 45-49.
24.	Athanasiou T, Aziz O, Mangoush O, et al. Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. Eur J Cardiothorac Surg, 2004, 26(4): 701-710.
25.	Almassi GH, Hawkins RB, Bishawi M, et al. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. J Thorac Cardiovasc Surg, 2019.
26.	Steinberg BA, Zhao Y, He X, et al. Management of postoperative atrial fibrillation and subsequent outcomes in contemporary patients undergoing cardiac surgery: Insights from the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry. Clin Cardiol, 2014, 37(1): 7-13.
27.	Yonezawa Y, Horinaka S, Shirakawa C, et al. Estimated glomerular filtration ratio is a better index than creatinine clearance (Cockcroft-Gault) for predicting the prevalence of atrial fibrillation in the general Japanese population. Hypertens Res, 2018, 41(6): 451-459.
28.	Franczyk B, Gluba-Brzózka A, Ciałkowska-Rysz A, et al. The problem of atrial fibrillation in patients with chronic kidney disease. Curr Vasc Pharmacol, 2016, 14(3): 260-265.
29.	Li M, Liu T, Luo D, et al. Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation. Cardiol J, 2014, 21(1): 89-95.
30.	Vaidya K, Semsarian C, Chan KH. Atrial fibrillation in hypertrophic cardiomyopathy. Heart Lung Circ, 2017, 26(9): 975-982.
31.	Huang CY, Yang YH, Lin LY, et al. Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy. Heart, 2018, 104(15): 1276-1283.
32.	王小易, 赵艳, 郑哲. 心脏外科术后新发心房颤动的围术期处理. 中国胸心血管外科临床杂志, 2020, 27(6): 700-703.

1. Rezaei Y, Peighambari MM, Naghshbandi S, et al. Postoperative atrial fibrillation following cardiac surgery: From pathogenesis to potential therapies. Am J Cardiovasc Drugs, 2020, 20(1): 19-49.
2. Axtell AL, Moonsamy P, Melnitchouk S, et al. Preoperative predictors of new-onset prolonged atrial fibrillation after surgical aortic valve replacement. J Thorac Cardiovasc Surg, 2020, 159(4): 1407-1414.
3. Elliott PM, Anastasakis A, Borger MA, et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J, 2014, 35(39): 2733-2779.
4. Garg L, Gupta M, Sabzwari SRA, et al. Atrial fibrillation in hypertrophic cardiomyopathy: Prevalence, clinical impact, and management. Heart Fail Rev, 2019, 24(2): 189-197.
5. Tang B, Song Y, Cui H, et al. Prediction of mid-term outcomes in adult obstructive hypertrophic cardiomyopathy after surgical ventricular septum myectomy. J Am Coll Cardiol, 2017, 70(16): 2092-2094.
6. Watanabe H, Watanabe T, Sasaki S, et al. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: The Niigata preventive medicine study. Am Heart J, 2009, 158(4): 629-636.
7. Massicotte-Azarniouch D, Kuwornu JP, Carrero JJ, et al. Incident atrial fibrillation and the risk of congestive heart failure, myocardial infarction, end-stage kidney disease, and mortality among patients with a decreased estimated GFR. Am J Kidney Dis, 2018, 71(2): 191-199.
8. Chua SK, Shyu KG, Lu MJ, et al. Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: Role beyond the CHA2DS2-VASc score. Europace, 2015, 17(9): 1363-1370.
9. 申志祥, 刘宇, 刘敏, 等. 基于肌酐与胱抑素的肾小球滤过率估算方程对人群肾功能分期的评价及应用. 中华流行病学杂志, 2017, 38(11): 1557-1562.
10. Wang S, Cui H, Yu Q, et al. Excision of anomalous muscle bundles as an important addition to extended septal myectomy for treatment of left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg, 2016, 152(2): 461-468.
11. Yamashita K, Hu N, Ranjan R, et al. Clinical risk factors for postoperative atrial fibrillation among patients after cardiac surgery. Thorac Cardiovasc Surg, 2019, 67(2): 107-116.
12. Filardo G, Damiano RJ, Ailawadi G, et al. Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery. Heart, 2018, 104(12): 985-992.
13. Guo Y, Wu X, Zheng X, et al. Usefulness of preoperative transforming growth factor-beta to predict new onset atrial fibrillation after surgical ventricular septal myectomy in patients with obstructive hypertrophic cardiomyopathy. Am J Cardiol, 2017, 120(1): 118-123.
14. Song C, Wang S, Guo Y et al. Plasma big endothelin-1 predicts new-onset atrial fibrillation after surgical septal myectomy in patients with hypertrophic cardiomyopathy. BMC Cardiovasc Disord, 2019, 19(1): 122.
15. Kinoshita T, Asai T, Ishigaki T, et al. Preoperative heart rate variability predicts atrial fibrillation after coronary bypass grafting. Ann Thorac Surg, 2011, 91(4): 1176-1181.
16. Ismail MF, El-Mahrouk AF, Hamouda TH et al. Factors influencing postoperative atrial fibrillation in patients undergoing on-pump coronary artery bypass grafting, single center experience. J Cardiothorac Surg, 2017, 12(1): 40.
17. Nguyen A, Schaff HV, Sedeek AF, et al. Septal myectomy and concomitant coronary artery bypass grafting for patients with hypertrophic cardiomyopathy and coronary artery disease. Mayo Clin Proc, 2020, 95(3): 521-525.
18. 李延培, 屈正, 刘晓峥, 等. 非体外冠脉搭桥术后新发房颤的相关危险因素分析. 中国心血管病研究, 2015, 13(3): 275-278.
19. Njoku A, Kannabhiran M, Arora R, et al. Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: A meta-analysis. Europace, 2018, 20(1): 33-42.
20. Lee JS, Shim CY, Wi J, et al. Left ventricular diastolic function is closely associated with mechanical function of the left atrium in patients with paroxysmal atrial fibrillation. Circ J, 2013, 77(3): 697-704.
21. Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet, 2013, 381(9862): 242-255.
22. Almassi GH, Pecsi SA, Collins JF, et al. Predictors and impact of postoperative atrial fibrillation on patients' outcomes: A report from the randomized on versus off bypass trial. J Thorac Cardiovasc Surg, 2012, 143(1): 93-102.
23. Hashemzadeh K, Dehdilani M, Dehdilani M. Does off-pump coronary artery bypass reduce the prevalence of atrial fibrillation? J Cardiovasc Thorac Res, 2013, 5(2): 45-49.
24. Athanasiou T, Aziz O, Mangoush O, et al. Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. Eur J Cardiothorac Surg, 2004, 26(4): 701-710.
25. Almassi GH, Hawkins RB, Bishawi M, et al. New-onset postoperative atrial fibrillation impact on 5-year clinical outcomes and costs. J Thorac Cardiovasc Surg, 2019.
26. Steinberg BA, Zhao Y, He X, et al. Management of postoperative atrial fibrillation and subsequent outcomes in contemporary patients undergoing cardiac surgery: Insights from the Society of Thoracic Surgeons CAPS-Care Atrial Fibrillation Registry. Clin Cardiol, 2014, 37(1): 7-13.
27. Yonezawa Y, Horinaka S, Shirakawa C, et al. Estimated glomerular filtration ratio is a better index than creatinine clearance (Cockcroft-Gault) for predicting the prevalence of atrial fibrillation in the general Japanese population. Hypertens Res, 2018, 41(6): 451-459.
28. Franczyk B, Gluba-Brzózka A, Ciałkowska-Rysz A, et al. The problem of atrial fibrillation in patients with chronic kidney disease. Curr Vasc Pharmacol, 2016, 14(3): 260-265.
29. Li M, Liu T, Luo D, et al. Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation. Cardiol J, 2014, 21(1): 89-95.
30. Vaidya K, Semsarian C, Chan KH. Atrial fibrillation in hypertrophic cardiomyopathy. Heart Lung Circ, 2017, 26(9): 975-982.
31. Huang CY, Yang YH, Lin LY, et al. Renin-angiotensin-aldosterone blockade reduces atrial fibrillation in hypertrophic cardiomyopathy. Heart, 2018, 104(15): 1276-1283.
32. 王小易, 赵艳, 郑哲. 心脏外科术后新发心房颤动的围术期处理. 中国胸心血管外科临床杂志, 2020, 27(6): 700-703.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors and predictive value of estimated glomerular filtration rate for new-onset atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy after modified extended Morrow procedure

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