Article

The association between postoperative atrial fibrillation (POAF) and
renal function was previously grounded in patients undergoing coronary artery
bypass grafting through unknown mechanisms. We aim to investigate the association
between renal function and POAF in a cohort composed mostly of patients
undergoing valve surgery and to explore the role of inflammation as a pathogenic
mechanism linking renal dysfunction and arrhythmogenesis.
METHODS: Altogether 444
patients who underwent cardiac surgery without previous history of atrial
fibrillation were analysed. Serum creatinine and high sensitivity C-reactive
protein (hs-CRP) concentrations were obtained at baseline and on the 3rd, 8th and
15th postoperative day; estimated glomerular filtration rate (eGFR) was
calculated by the Modified Diet Renal Disease (MDRD) formula. Patients were
divided into three groups on the basis of baseline eGFR. RESULTS: Overall, 173
(39%) patients developed POAF, 29.5% in the group with normal eGFR (>/=90
ml/min/1.73 m(2)), 43.3% among patients with eGFR 60-90 ml/min/1.73 m(2) and
55.6% in the group with eGFR </=60 ml/min/1.73 m(2). Patients developing POAF had
lower eGFR on all the samples. At baseline preoperatively hs-CRP levels did not
differ in the two groups.On multivariate analysis, age and eGFR were identified
as independent predictors of POAF. The risk of POAF progressively increased from
mild impairment (odds ratio (OR) 1.59, 95% confidence interval (CI) 1.01-2.50) to
severe reduction of renal function (OR 2.35, 95% CI 1.25-4.48). CONCLUSIONS: Age
and eGFR were identified as the strongest predictors of POAF in a population
largely composed of valve surgery patients. Renal function, even from early
stage, is independently associated with the increasing risk of developing POAF.
CI - (c) The European Society of Cardiology 2014.

Langue : ANGLAIS