Disfunción auricular izquierda y fibrilación auricular de reciente comienzo en cirugía cardiaca / Left atrial dysfunction and new-onset atrial fibrillation after cardiac surgery

RESUMEN

Introducción y objetivos. La fibrilación auricular postoperatoria es una complicación frecuente de la cirugía cardiaca con circulación extracorpórea (CEC). Hemos estudiado si la función contráctil auricular izquierda preoperatoria evaluada mediante ecocardiografía Doppler tisular se asocia a la aparición de fibrilación auricular postoperatoria (FAP) de reciente comienzo. Métodos. Realizamos una ecocardiografía transtorácica preoperatoria a pacientes intervenidos de cirugía cardiaca electiva. La función contráctil auricular izquierda se evaluó mediante el análisis por Doppler tisular del anillo mitral (DTm). Resultados. Estudiamos a 92 pacientes en ritmo sinusal previo intervenidos de cirugía coronaria electiva con CEC, 73 (79%) varones y 19 (21%) mujeres, con una media de edad de 67 ± 10 años; 19 (20,6%) pacientes presentaron FAP en torno a las 34 ± 12 h postoperatorias. En el análisis bivariable, una edad mayor (71 ± 7 frente a 66 ± 10; p = 0,034), un mayor tamaño de la aurícula izquierda (TAI), una menor velocidad del pico sistólico auricular del anillo mitral (a) y una mayor relación e/a (DTm) se asociaron con la FAP. En el análisis de regresión logística, el TAI (odds ratio [OR] = 2,23; intervalo de confianza [IC] del 95%, 1,05-4,76; p = 0,033) y una menor (a) (OR = 0,70; IC del 95%, 0,55-0,99; p = 0,034) se asociaron de forma independiente con la FAP. Conclusiones. Una disfunción auricular izquierda preoperatoria evaluada mediante DTm se asoció con un mayor riesgo de FAP (AU)

ABSTRACT

Introduction and objectives. Postoperative atrial fibrillation is a common complication of carrying out cardiac surgery with extracorporeal circulation (ECC). The aim of this study was to determine whether preoperative left atrial contractile dysfunction, as assessed by tissue Doppler echocardiography, is associated with the development of postoperative new-onset atrial fibrillation (PAF).Methods. Transthoracic Doppler echocardiography was performed preoperatively in patients undergoing elective cardiac surgery. Left atrial contractile function was evaluated by tissue Doppler imaging (TDI) of the mitral annulus. Results. The study included 92 patients in sinus rhythm preoperatively who underwent elective cardiac surgery with ECC: 73 (79%) were male and 19 (21%) were female, and their mean age was 67±10 years. Of these, 19 (20.6%) developed PAF 34±12 h postoperatively. Bivariate analysis showed that PAF was associated with older age (71±7 years vs. 66±10 years; P=.034), a large left atrial diameter (LAD), and a low peak atrial systolic mitral annular velocity (A velocity) and a high mitral E/A ratio on TDI. Logistic regression analysis showed that PAF was independently associated with a large LAD (odds ratio [OR]=2.23; 95% confidence interval [CI], 1.05-4.76; P=.033) and a low A velocity (OR=0.70; 95%CI, 0.55-0.99; P=.034).Conclusions. Preoperative left atrial dysfunction, as assessed by TDI, was associated with an increased risk of PAF (AU)