Preoperative plasma aldosterone and the risk of atrial fibrillation after coronary artery bypass surgery: a prospective cohort study
Preoperative plasma aldosterone and the risk of atrial fibrillation after coronary artery bypass surgery: a prospective cohort study
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DOI：
10.1097/hjh.0000000000001105
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发表时间：
2016-12-01
影响因子：
4.9
通讯作者：
Milliez, Paul
中科院分区：
文献类型：
--
作者：
Alexandre, Joachim;Saloux, Eric;Milliez, Paul
目的：冠状动脉旁路移植术（CABG）术后房颤（POAF）与不良结局相关。我们的目的是评估额外的价值术前血浆醛固酮水平，生物标志物，促进促血管生成和促纤维化的途径，预测POAF后CABG。方法：我们进行了一项前瞻性队列研究，涉及连续患者左心室射血分数（LVEF）超过50%，需要择期CABG在我们的大学医院。术前测定血浆醛固酮水平、二维超声心动图（包括左房应变分析）和半乳糖凝集素-3（Gal-3）。结果：137例患者中有34例（24.8%）发生POAF。与对照组相比，POAF患者年龄明显更大（73岁+/- 8 vs 65 +/- 11，P < 0.001），术前血浆醛固酮水平更高[183 pmol/l（四分位距138-300）vs 143 pmol/l（四分位距96.5-216.5），P < 0.01]。年龄[比值比（OR），1.088; 95%置信区间（CI）]（1.038-1.140）; P - 0.0004]和血浆醛固酮水平[OR，1.007; 95%CI（1.003-1.012）; P - 0.0013]在多变量分析中与POAF独立相关，因此可以联合预测POAF的发生率，OR，2.7; 95%CI（1.7-4.3）; P < 0.0001]。右心耳和血浆检查进行逆转录酶PCR分析显示，半乳糖苷酶-3激活POAF patients.Conclusion：我们制定了术前的“Aldosore”POAF风险分层患者保留LVEF需要择期CABG。这种新的工具可能有助于识别针对醛固酮的促肾上腺皮质激素和促纤维化途径的干预措施的良好反应者。
Objective: Postoperative atrial fibrillation (POAF) is associated with poor outcomes after coronary artery bypass graft (CABG) surgery. We aimed to assess the additional value of preoperative plasma aldosterone levels, a biomarker promoting proarrhythmic and profibrotic pathways, for predicting POAF after CABG.Methods: We conducted a prospective cohort study involving consecutive patients with left ventricular ejection fraction (LVEF) more than 50% requiring elective CABG in our university hospital. Plasma aldosterone levels, two-dimensional echocardiography including left atrial strain analysis and galectin-3 (Gal-3) examination were assessed before cardiac surgery. The primary endpoint was the occurrence of POAF within 30 days after surgery.Results: POAF occurred in 34 (24.8%) out of the 137 included patients. Compared with controls, patients experiencing POAF were significantly older (73 years old +/- 8 vs 65 +/- 11, P < 0.001) and had higher preoperative plasma aldosterone levels [183 pmol/l (interquartile range 138-300) vs 143 pmol/l (interquartile range 96.5-216.5), P < 0.01]. Age [odds ratio (OR), 1.088; 95% confidence interval (CI) (1.038-1.140); P - 0.0004] and plasma aldosterone levels [OR, 1.007; 95% CI (1.003-1.012); P - 0.0013] were independently associated with POAF in multivariate analysis and could therefore be combined to predict the occurrence of POAF ['Aldoscore', OR, 2.7; 95% CI (1.7-4.3); P < 0.0001]. Reverse transcriptase PCR analysis performed on right atrial appendage and plasma examination revealed that Gal-3 was activated in POAF patients.Conclusion: We developed the preoperative 'Aldoscore' for POAF risk stratification among patients with preserved LVEF requiring elective CABG. This new tool may be helpful to identify good responders to interventions targeting the proarrhythmic and profibrotic pathways of aldosterone.