Low Circulating Levels of Growth Differentiation Factor-15 Before Coronary Artery Bypass Surgery May Predict Postoperative Atrial Fibrillation
Low Circulating Levels of Growth Differentiation Factor-15 Before Coronary Artery Bypass Surgery May Predict Postoperative Atrial Fibrillation
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DOI：
10.1053/j.jvca.2015.01.023
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发表时间：
2015-10-01
影响因子：
2.8
通讯作者：
Laurent, Gabriel
中科院分区：
文献类型：
--
作者：
Bouchot, Olivier;Guenancia, Charles;Laurent, Gabriel
目的：评估生长分化因子-15（GDF-15）作为非体外循环（OFP）和体外循环（ONP）冠状动脉旁路移植术（CABG）术后房颤（POAF）潜在新预测因子的作用。设计：前瞻性、单中心、观察性研究。设置：大学教学医院。参与者：在接受CABG的患者中，前50例计划接受OFP手术的患者和前50例计划接受ONP手术的患者符合以下排除标准：年龄80岁，既往房颤/房扑，既往胺碘酮治疗，既往心脏手术和急诊手术。干预措施：包括患者配备了长期（7天）Molter-ECG monitoring.Measurements和主要结果：POAF被定义为AF发作持续时间>30秒。所有患者术前均接受超声心动图检查，以评估左心室射血分数和左心房直径。在麻醉诱导后和到达重症监护室后12小时评估GDF-15水平。在100例患者中，34例（34%）发生POAF。在考克斯多变量回归分析中，EuroSCORE、左心房直径>45 mm和诱导时低GDF-15水平与POAF的发生独立相关。相比之下，术前NT-proBNP水平不能预测POAF。ONP手术的使用与POAF的发病率较高，即使基线和后续的特点在ONP和OFP patients.Conclusions：在没有AF病史的患者，低血浆GDF-15水平CABG手术前是一个强大的POAF的独立预测因素。此外，术前血浆GDF-15水平增加了POAF经典危险因素的预测价值。(C)2015 Elsevier Inc. All rights reserved.
Objectives: To assess the role of growth differentiation factor-15 (GDF-15) as a potential new predictor of postoperative atrial fibrillation (POAF) after off-pump (OFP) and on-pump (ONP) coronary artery bypass graft (CABG) surgery.Design: Prospective, single-center, observational study.Setting: University teaching hospital.Participants: The first 50 patients planned for OFP surgery and the first 50 patients planned for ONP surgery among patients referred for CABG with the following exclusion criteria: age 80 years, previous atrial fibrillation/flutter, previous treatment with amiodarone, previous cardiac surgery, and emergency surgery.Interventions: Included patients were equipped with long-duration (7 days) Molter-ECG monitoring.Measurements and Main Results: POAF was defined as an AF episode lasting >30 seconds. All patients underwent preoperative echocardiography to assess left ventricular ejection fraction and left atrial diameter. GDF-15 levels were assessed after induction of anesthesia and 12 hours after arrival at the intensive care unit. Among the 100 patients, 34 (34%) developed POAF. In Cox multivariate regression analysis, the EuroSCORE, left atrial diameter >45 mm, and low GDF-15 levels at induction were associated independently with the onset of POAF. In contrast, preoperative NT-proBNP levels did not predict POAF. The use of ONP surgery was not associated with a higher incidence of POAF, even though baseline and follow-up characteristics in ONP and OFP patients were identical.Conclusions: In patients with no history of AF, a low plasma level of GDF-15 before CABG surgery was a strong independent predictor of POAF. Moreover, preoperative plasma GDF-15 levels added an incremental predictive value to classic risk factors of POAF. (C) 2015 Elsevier Inc. All rights reserved.