Left Atrial Size Contribution to the Predictive Capacity of Two Scores for Atrial Fibrillation in the Postoperative Period of Cardiac Surgeries

Silva, Natália Aline da; Butcher, Rita de Cássia Gengo e Silva

doi:10.5935/2359-4802.20190042

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International Journal of Cardiovascular Sciences

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ORIGINAL ARTICLE • Int. J. Cardiovasc. Sci. 32 (6) • Nov-Dec 2019 • https://doi.org/10.5935/2359-4802.20190042 copy

Left Atrial Size Contribution to the Predictive Capacity of Two Scores for Atrial Fibrillation in the Postoperative Period of Cardiac Surgeries

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Postoperative atrial fibrillation (POAF) is a common complication associated with undesirable outcomes; hence, the provision of appropriate tools is important to help identify patients at risk.

Objectives:

To evaluate the predictive capacity of the CHADS₂ and CHA₂DS₂-VASc scores, alone and combined with left atrial (LA) size, for the onset of POAF in patients undergoing coronary artery bypass grafting and/or valvular surgery.

Methods:

We performed a retrospective cohort study on 144 patients. A decision tree was used to identify the cut-off values of the CHADS₂ and CHA₂DS₂-VASc scores and LA size in order to calculate sensitivity, specificity, predictive-value positive (PVP), and predictive-value negative (PVN), in addition to regression models. The receiver operating characteristic (ROC) curve was used to estimate the accuracy of the models. The level of significance adopted was 5%.

Results:

Patients who developed POAF were older (p = 0.050), had reduced left ventricular ejection fraction (p = 0.045), longer hospital length of stay (p = 0,018), but their mean CHADS₂ (p = 0.077) and CHA₂DS₂-VASc (p = 0.109) scores were similar to those of patients with no arrhythmia. LA size improved the predictive capacity of the CHADS₂ score, in terms of specificity and PVP, and of the CHA₂DS₂-VASc score, in terms of sensitivity and PVN. However, the CHADS₂ (OR = 1.198; CI95% = 0.859-1.156) and CHA₂DS₂-VASc (OR = 1.047; CI95% = 0.784-1.401) scores were not predictors of POAF, either alone or in combination with LA size (OR = 1.163; CI95% = 0.829-1.648 and OR = 1.065; CI95% = 0.795-1.433).

Conclusion:

The CHADS₂ and CHA₂DS₂-VASc scores alone or in combination with LA size did not show good predictive capacity for POAF.

Keywords:
Atrial Fibrillation; Arrhythmias, Cardiac/complications; Postoperative Complications; Cardiac Surgical Procedures

	With POAF	Without POAF	p-value
Age, in years, mean (SD)	65.8 (10.7)	61.8 (13.3)	0.050^* *()** Student's t-test;
Male gender, n(%)	44 (61.1)	47 (65.3)	0.604^† (†) Pearson's chi-square test.
Skin color, n(%)			0.678^† (†) Pearson's chi-square test.
White	61 (84.7)	61 (84.7)
Other	11 (15.3)	9 (12.5)
Not informed		2 (2.8)
Active smoking, n(%)	9 (12.5)	12 (16.6)	0.478^† (†) Pearson's chi-square test.
Preoperative echocardiographic data
Left atrial size, in mm, mean (SD)	43.4 (6.6)	41.3 (6.3)	0.059^* *()** Student's t-test;
LVDd, mm, mean (SD)	53.3 (7.7)	52.1 (7.0)	0.359^* *()** Student's t-test;
LVEF %, mean (SD)	55.3 (12.4)	59.2 (10.6)	0.045^* *()** Student's t-test;

	Minimum	p-value^* *()** Student's t-test.	Maximum	p-value^* *()** Student's t-test.
Magnesium, mEq/L, mean (SD)
With AF	1.5 (0.4)	0.248	2.1 (0.5)	0.950
Without AF	1.6 (0.4)	0.248	2.1 (0.6)	0.950
Potassium, mEq/L, mean (SD)
With AF	3.8 (0.4)	0.251	4.4 (0.5)	0.780
Without AF	3.9 (0.9)	0.251	4.4 (0.9)	0.780
Sodium, mEq/L, mean (SD)
With AF	135.5 (3.2)	0.194	138.9 (3.7)	0.404
Without FA	136.6 (6.1)	0.194	139.6 (5.9)	0.404
Calcium, mEq/L, mean (SD)
With AF	1.15 (0.06)	0.406	1.25 (0.1)	0.984
Without AF	1.16 (0.06)	0.406	1.25 (0.1)	0.984
CRP, mEq/L, mean (SD)
With AF	8.4 (11.0)	0.019	111.1 (69.7)	0.099
Without AF	16.8 (27.4)	0.019	92.6 (64.1)	0.099
Creatinine, mEq/L, mean (SD)
With AF	1.0 (0.4)	0.277	1.4 (0.6)	0.601
Without AF	1.3 (1.6)	0.277	1.6 (1.7)	0.601
Urea, mEq/L, mean (SD)
With AF	38.1 (16.0)	0.840	48.0 (22.1)	0.210
Without AF	38.7 (18.5)	0.840	43.6 (19.8)	0.210

	With POAF (n = 72)	Without POAF (n = 72)	p-value
Type of surgery, n(%)
Coronary artery bypass grafting	36 (50.0)	35 (48.7)	1.000^* *()** Fisher's exact test;
Valvular surgery	32 (44.4)	32 (44.4)
Both	4 (5.6)	5 (6.9)
ECC, n (%)	68 (94.4)	65 (90.2)	0.346^† (†) Pearson's chi-squared test;
Time of ECC, in hours, mean (SD)	1.4 (0.5)	1.5 (0.8)	0.726^‡ (‡) Student's t-test.
Time of anesthesia, in hours, mean (SD)	7.2 (1.3)	7.3 (1.8)	0.640^‡ (‡) Student's t-test.
Use of VAD in IPO, n (%)	71 (98.6)	72 (100.0)	1.000^* *()** Fisher's exact test;
Total length of stay, in days, mean (SD)	17.8 (13.3)	12.6 (12.4)	0.018^‡ (‡) Student's t-test.
Death, n (%)	3 (4.1)	10 (13.8)	0.042^† (†) Pearson's chi-squared test;

	CHADS₂ > 0.5	CHA₂DS₂VASc < 3.5	CHADS₂ > 0.5 and LA > 39.5 mm	CHA₂DS₂VASc < 3.5 and LA > 50.5 mm
Sensitivity	91.7	52.8	68.1	65.3
Specificity	25.0	68.1	59.7	61.1
Predictive value positive	55.0	62.3	62.8	62.7
Predicitive value negative	75.0	59.0	65.1	63.8

		Odds ratio (CI 95%)	p-valor	AUC (CI 95%)
Model 1	CHADS₂	1.198 (0.859-1.156)	0.291	0.611 (0.518-0.714)
Model 2	CHADS₂	1.163 (0.829-1.648)	0.387	0.643 (0.552-0.733)
	LA size	1.049 (0.995-1.107)	0.078

		Odds ratio (IC 95%)	p-valor	AUC (CI 95%)
Model 3	CHA₂DS₂VASc	1.047 (0.784-1.401)	0.754	0.590 (0.497-0.683)
Model 4	CHA₂DS₂VASc	1.065 (0.795-1.433)	0.673	0.633 (0.542-0.724)
	LA size	1.052 (0.999-1.110)	0.061

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