Predictive value of preoperative echocardiographic assessment for postoperative atrial fibrillation after esophagectomy for esophageal cancer
Predictive value of preoperative echocardiographic assessment for postoperative atrial fibrillation after esophagectomy for esophageal cancer
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DOI：
10.1007/s10388-020-00804-y
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发表时间：
2021-01-29
期刊：
影响因子：
2.4
通讯作者：
Yano, Masahiko
中科院分区：
文献类型：
--
作者：
Nagatsuka, Yuta;Sugimura, Keijiro;Yano, Masahiko
背景 食管癌食管切除术后发生术后心房颤动 (POAF) 并不罕见。本研究的目的是探讨术前经胸超声心动图是否有助于预测食管癌新发 POAF。方法在这项前瞻性观察研究中，我们对2016年1月至2019年7月期间在我院接受食管切除术的200例食管癌患者进行了评估。术前进行了常规超声心动图评估和组织多普勒成像。我们研究了术前经胸超声心动图在预测食管癌新发 POAF 方面的实用性。结果 200 名患者中有 51 名（25.5%）发生新发 POAF。 POAF 与年龄较大 (p = 0.007)、较高的体重指数 (p = 0.020)、术前高血压疾病 (p = 0.021) 和较低的血红蛋白水平 (p = 0.028) 显着相关。 POAF 患者术后并发症的发生率显着高于非 POAF 患者（43.1% vs. 24.2%，p = 0.013）。经胸超声心动图显示，POAF 患者的左心房直径 (LAD) 和 E 波/e'波比 (E/e') 显着高于非 POAF 患者（分别为 34.1 vs. 31.3 mm，p < 0.001 和 11.6 vs. 10.5，p = 0.003）。多变量分析显示，LAD >= 36.0 mm、E/e' >= 8.4 是 POAF 的独立危险因素（优势比分别为 2.47 和 3.64；p 值分别为 0.035 和 0.027）。 结论 术前超声心动图评估有助于预测食管癌食管切除术后 POAF 的发生。使用 LAD 和 E/e 进行风险分层使临床医生能够在食管切除术之前识别 POAF 高风险患者。
Background Postoperative atrial fibrillation (POAF) after esophagectomy for esophageal cancer is not uncommon. The aim of this study is to examine whether preoperative transthoracic echocardiography is useful for predicting new-onset POAF in esophageal cancer. Methods In this prospective observational study, we evaluated 200 patients with esophageal cancer who underwent esophagectomy at our hospital between January 2016 and July 2019. Conventional echocardiographic assessment and tissue Doppler imaging were performed before surgery. We investigated the utility of preoperative transthoracic echocardiography for predicting new-onset POAF in esophageal cancer. Results New-onset POAF occurred in 51 (25.5%) of 200 patients. POAF was significantly associated with older age (p = 0.007), higher body mass index (p = 0.020), preoperative hypertensive disease (p = 0.021), and lower hemoglobin level (p = 0.028). The incidence of postoperative complications was significantly higher in patients with POAF than in patients without POAF (43.1% vs. 24.2%, p = 0.013). Transthoracic echocardiography showed that left atrial diameter (LAD) and E wave/e ' wave ratio (E/e ') were significantly higher in patients with POAF than in patients without POAF (34.1 vs. 31.3 mm, p < 0.001 and 11.6 vs. 10.5, p = 0.003, respectively). Multivariate analysis showed that LAD >= 36.0 mm, E/e ' >= 8.4 are independent risk factors for POAF (odds ratios 2.47 and 3.64; p values 0.035 and 0.027, respectively) Conclusions Preoperative echocardiographic evaluation is useful for predicting the onset of POAF after esophagectomy for esophageal cancer. Risk stratification using LAD and E/e ' enables clinicians to identify patients at high risk for POAF before esophagectomy.