Predicting postoperative atrial fibrillation after off-pump coronary artery bypass surgery-an ongoing story.
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ABSTRACT:
SUBMITTER: Chia AXF
PROVIDER: S-EPMC10636482 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Predicting postoperative atrial fibrillation after off-pump coronary artery bypass surgery-an ongoing story.
Chia Alicia X F AXF Pang Philip Y K PYK
Journal of thoracic disease 20231007 10
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Project description:Rationale: Circular RNAs are pervasively expressed in highly diverged eukaryotes. Circular RNAs are more stable in body fluids, however, the link between circular RNA and onset of atrial fibrillation has never been investigated. Objective: To identify plasma circular RNAs for diagnosing onset of atrial fibrillation after the cardiac surgery. Methods and Results: Plasma circular RNAs expression was investigated in participants underwent isolated off-pump coronary artery bypass grafting. First, we used microarray to screen 15 circular RNAs in 30 plasma samples for diagnosing new onset of atrial fibrillation. Quantitative polymerase chain reaction assay was then applied to evaluate the expression of selected circular RNAs. Hsa_circRNA_025016 was upregulated in patients with onset of atrial fibrillation, with a high diagnostic accuracy by area under the receiver operating characteristic curve. The satisfactory diagnostic performance of hsa_circRNA_025016 persisted in validation cohort. Kyoto Encyclopedia of Genes and Genomes biological pathway analysis indicated that hsa_circ_025016 could participate in melanogenesis, insulin secretion, and thyroid hormone signaling pathway. There was a positive correlation between hsa_circ_025016 and fast blood glucose in both cohorts. Conclusions: Hsa_circ_025016 is a novel biomarker of onset of atrial fibrillation after isolated off-pump coronary artery bypass grafting.
2017-04-07 | GSE97455 | GEO
Project description:Background Circular RNAs (circRNAs) are pervasively expressed in highly divergent eukaryotes and are stable in body fluids. However, the link between circRNAs and onset of atrial fibrillation (AF) has not previously been investigated. We aimed to identify plasma circRNAs that are able predict AF after cardiac surgery. Methods and Results Plasma circRNA expression profiles were investigated in a total of 769 patients with or without AF after isolated off?pump coronary artery bypass grafting. First, a circRNA microarray was used to screen 13 617 human circRNAs in plasma samples from patients in the discovery cohort (n=30). A quantitative polymerase chain reaction assay was then applied to evaluate the expression of 9 selected circRNAs in the training cohort (n=365). This approach revealed that hsa_circRNA_025016 was upregulated in patients with new?onset AF with a high diagnostic accuracy as assessed by the area under the receiver operating characteristic curve (=0.802). Additionally, a satisfactory diagnostic performance of hsa_circRNA_025016 was found in the validation cohort (n=284). Furthermore, Kyoto Encyclopedia of Genes and Genomes biological pathway analysis indicated that hsa_circ_025016 participated in melanogenesis, insulin secretion, and the thyroid hormone signaling pathway. A positive correlation between hsa_circ_025016 and fasting blood glucose was also identified in both cohorts. Conclusions Hsa_circ_025016 is a potential biomarker for predicting new?onset AF after isolated off?pump coronary artery bypass grafting.
| S-EPMC5850143 | biostudies-literature
Project description:Postoperative atrial fibrillation (POAF) is linked with increased morbidity, mortality rate and financial liability. About 20-50% of patients experience POAF after coronary artery bypass graft (CABG) surgery. Numerous review articles and meta-analyses have investigated links between patient clinical risk factors, demographic conditions, and pre-, peri- and post-operative biomarkers to forecast POAF incidence in CABG patients. This narrative review, for the first time, summarize the role of micro-RNAs, circular-RNAs and other gene expressions that have shown experimental evidence to accurately predict the POAF incidence in cardiac surgery patients after CABG. We envisage that identifying specific genomic markers for predicting POAF might be a significant step for the prevention and effective management of this type of post-operative complication and may provide critical perspective into arrhythmogenic substrate responsible for POAF.
| S-EPMC7231013 | biostudies-literature
Project description:Postoperative atrial fibrillation (POAF) is a serious yet common complication after coronary artery bypass grafting (CABG) surgery. Previous study have identified multiple genetic susceptibility loci for POAF susceptibility after CABG, although some studies are under-powered. However, none of these studies have been conducted among Asians. In current study, we aim to systematically evaluated the previous positive findings for POAF susceptibility after CABG among Chinese population, using a large population-based, two-stage, case-cohort study. From a discovery cohort of 1,348 patients, a total of nine independent loci were evaluated. Six significant SNPs were then assessed in a separately collected validation cohort of 2,000 patients. After adjustment for clinical predictors of POAF, two variants in GRK5 gene (rs4752292, and rs11198893) were replicated with significance were replicated in the validation cohort. The ORs for each additional copy of minor allele were 1.32 (95% CI: 1.15-1.50, P = 5.82 × 10(-5)) and 1.47 (95% CI: 1.28-1.69, P = 1.16 × 10(-7)), respectively. In this two-stage independently collected cardiac surgery cohorts, genetic variations in the GRK5 gene are independently associated with POAF risk in patients who undergo CABG surgery in Asians.
| S-EPMC4522662 | biostudies-literature
Project description:BackgroundThe aim of this study was to evaluate the efficacy of early amiodarone-based pharmacological cardioversion for postoperative atrial fibrillation (POAF) following off-pump coronary bypass grafting (OPCAB).MethodsA total of 507 patients who underwent OPCAB between 2015 and 2017 were categorized into POAF (n=94) and no-POAF (n=413) groups. Patients in the POAF group were treated according to the following institutional protocol: 150 mg loading dose of intravenous amiodarone, followed by oral administration with sequential maintenance doses at 600, 400, and 200 mg per day. If sinus rhythm was restored before discharge, patients were discharged without amiodarone or anticoagulants, except for dual antiplatelets.ResultsBefore discharge at index hospitalization, 97.8% of POAF patients had restored sinus rhythm. Independent risk factors for POAF were age, unstable angina, prior percutaneous transluminal coronary angioplasty, and left atrial diameter. The mean follow-up duration was 41.1±12.8 months. Freedom from overall mortality and composite events, including mortality, major bleeding requiring admission and cerebrovascular events, were similar between the 2 groups. Results were consistent after propensity-score matching.ConclusionsAmiodarone-based rapid pharmacological cardioversion of POAF resulted in a high sinus rhythm conversion rate (97.9%). Rate of late adverse cardiovascular events including stroke, were low even without anticoagulation. As optimal treatment and anticoagulation guidelines for POAF after OPCAB have not yet been established, amiodarone-based treatment protocols may be considered as a useful option.
| S-EPMC8339786 | biostudies-literature
Project description:Background The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, previous stroke or TIA [transient ischemic attack], vascular disease, age 65 to 74 years, sex category female; 2 indicates 2 points, otherwise 1 point) scoring system is recommended to guide decisions on oral anticoagulation therapy for stroke prevention in patients with nonsurgery atrial fibrillation. A score ≥1 in men and ≥2 in women, corresponding to an annual stroke risk exceeding 1%, warrants long-term oral anticoagulation provided the bleeding risk is acceptable. However, in patients with new-onset postoperative atrial fibrillation, the optimal risk stratification method is unknown. The aim of this study was therefore to evaluate the CHA2DS2-VASc scoring system for estimating the 1-year ischemic stroke risk in patients with new-onset postoperative atrial fibrillation after coronary artery bypass grafting. Methods and Results All patients with new-onset postoperative atrial fibrillation and without oral anticoagulation after first-time isolated coronary artery bypass grafting performed in Sweden during 2007 to 2017 were eligible for this registry-based observational cohort study. The 1-year ischemic stroke rate at each step of the CHA2DS2-VASc score was estimated using a Kaplan-Meier estimator. Of the 6368 patients included (mean age, 69.9 years; 81% men), >97% were treated with antiplatelet drugs. There were 147 ischemic strokes during the first year of follow-up. The ischemic stroke rate at 1 year was 0.3%, 0.7%, and 1.5% in patients with CHA2DS2-VASc scores of 1, 2, and 3, respectively, and ≥2.3% in patients with a score ≥4. A sensitivity analysis, with the inclusion of patients on anticoagulants, was performed and supported the primary results. Conclusions Patients with new-onset atrial fibrillation after coronary artery bypass grafting and a CHA2DS2-VASc score <3 have such a low 1-year risk for ischemic stroke that oral anticoagulation therapy should probably be avoided.
| S-EPMC9238552 | biostudies-literature
Project description:BackgroundThis cohort study collected the clinical data of patients who underwent off-pump coronary artery bypass grafting (OPCABG) during hospitalization to observe the occurrence of postoperative atrial fibrillation (POAF), construct a POAF prediction model for CABG patients based on the left atrial diameter (LAD), and assist clinicians in making better medical decisions.MethodsIn this study, all patients who had no prior history of arrhythmia and who had received isolated OPCABG between May 1, 2021, and February 1, 2022, at Beijing Anzhen Hospital Affiliated to Capital Medical University (n=749) were reviewed. Depending on an optimal cutoff obtained from receiver operating characteristic (ROC) curve analysis, patients were separated into two groups: a group with POAF (n=188) and a group without POAF (n=561). The incidence of POAF was then compared. Prediction models were built, and nomograms were plotted was plotted. Model evaluation, including calibration curve and decision curve analysis, was performed.ResultsIn all, 188 out of 749 (25.1%) patients who underwent cardiac surgery experienced POAF. Multifactorial logistic regression analysis showed that age ≥66 years, LAD ≥39 mm, and post-OPCABG atrial fibrillation (AF) were independently associated. The prognostic nomogram model showed good concordance index (C-index) scores. Decision curve analysis suggested the clinical benefit of the prediction models.ConclusionsIn this study, a prediction model for patients with POAF after OPCABG was assessed, which was shown to make more accurate predictions compared with the original risk prediction system. It may assist doctors to optimize management of patients with POAF.
| S-EPMC10407488 | biostudies-literature
Project description:IntroductionPostoperative atrial fibrillation (AF) is a common complication of cardiac surgery that is associated with an increased incidence of other complications. This study evaluated the safety and efficacy of landiolol hydrochloride--an ultrashort-acting β1-selective blocker and highly regulated drug, positioned as a class 1 antiarrhythmic in Japan guidelines--for the prevention of AF after off-pump coronary artery bypass grafting (CABG).MethodsBetween January 2011 and November 2013, 116 patients underwent CABG at Fukuoka University Hospital. They were divided into two groups: group L consisted of patients who were administered landiolol hydrochloride at 2 μg/kg/min after completion of all distal anastomoses; group C was the control group consisting of patients who were not administered landiolol. Patient backgrounds, intraoperative variables and incidence of postoperative complications were compared.ResultsNo significant between-group differences were observed in patient backgrounds or incidence of complications other than postoperative AF, which occurred significantly less frequently in group L. After administration of landiolol, heart rate decreased but no change was observed in arterial pressure or other parameters, and patient hemodynamics remained stable.ConclusionIntraoperative and perioperative administration of low-dose landiolol has a preventive effect on the development of AF after CABG surgery.
| S-EPMC4209088 | biostudies-literature
Project description:The mechanism of development of atrial fibrillation (AF) in patients undergoing coronary artery bypass grafting (CABG) has not been clearly defined, and the involvement of multiple factors such as advanced age, withdrawal of β-blockers, inadequate atrial protection, and electrolyte imbalance, particularly hypomagnesemia has been documented by several authors. Despite all the available pharmacologic prophylaxis, incidence of AF still remains high in this group of patients. This unexplained cause could be genetic inheritance of endothelin-1 (ET-1) gene which is thought to have a pro-arrhythmogenic effect.This study aims to investigate the relationship between plasma ET-1 concentrations, ET-1 gene polymorphisms in loci -1370 T/G, -134 (3A/4A) Ins/del, Lys198Asn (G/T), and occurrence of AF in patients undergoing CABG.Ninety-eight nonrelated, nondiabetic patients over a period of 4 years undergoing routine CABG were selected for the present study. All patients were genotyped for three single nucleotide polymorphisms (SNPs) in loci -1370 T/G, -134 (3A/4A) Ins/del, and Lys198Asn (G/T) in the ET-1 gene by gene sequencing. The plasma ET-1 concentrations were measured using an ET immunoassay.Plasma ET-1 concentrations were higher in AF+ group (P = 0.001) as compared to AF- group. The allele frequencies between AF+ and AF- group were significantly different only with respect to the Lys198Asn (G/T) SNP of the ET-1 gene.The study described the possible correlation of polymorphism of ET gene in CABG population from India. The ET-1 gene might play a disease-modifying role in atrial fibrillation.
| S-EPMC5535579 | biostudies-other
Project description:BackgroundPostoperative atrial fibrillation (pAF) after coronary artery bypass grafting is a common complication. Whether pAF is associated with an increased risk of cerebrovascular accident (CVA) remains uncertain. We investigated the association between pAF and long-term risk of CVA by performing a post hoc analysis of 10-year outcomes of the ART (Arterial Revascularization Trial).MethodsFor the present analysis, among patients enrolled in the ART (n=3102), we excluded those who did not undergo surgery (n=25), had a history of atrial fibrillation (n=45), or had no information on the incidence of pAF (n=9). The final population consisted of 3023 patients, of whom 734 (24.3%) developed pAF with the remaining 2289 maintaining sinus rhythm. Competing risk and Cox regression analyses were used to investigate the association between pAF and the risk of CVA.ResultsAt 10 years, the cumulative incidence of CVA was 6.3% (4.6%-8.1%) versus 3.7% (2.9%-4.5%) in patients with pAF and sinus rhythm, respectively. pAF was an independent predictor of CVA at 10 years (hazard ratio, 1.53 [95% CI, 1.06-2.23]; P=0.025) even when CVAs that occurred during the index admission were excluded from the analysis (hazard ratio, 1.47 [95% 1.02-2.11]; P=0.04).ConclusionsPatients with pAF after coronary artery bypass grafting are at higher risk of CVA. These findings challenge the notion that pAF is a benign complication.
| S-EPMC7845484 | biostudies-literature