Predictive Value of QT Interval for Postoperative Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

Kumtepe, Gencehan; Ucaroglu, Erhan Renan

doi:10.21470/1678-9741-2020-0571

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Brazilian Journal of Cardiovascular Surgery

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ORIGINAL ARTICLE • Braz. J. Cardiovasc. Surg. 37 (06) • Nov-Dec 2022 • https://doi.org/10.21470/1678-9741-2020-0571 copy

Predictive Value of QT Interval for Postoperative Atrial Fibrillation in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Introduction:

Postoperative atrial fibrillation (poAF) is a common complication of coronary artery bypass grafting, and its reasons are still the subject of research. The aim of this study was to evaluate whether QT interval is related to new onset of poAF occurrence.

Methods:

This study included 167 patients undergoing elective isolated off-pump coronary artery bypass grafting (OPCAB) surgery. Patients were divided into two groups as poAF (+) and poAF (-), according to the development of poAF, and the results of the measurements were compared between the groups.

Results:

PoAF was detected in 37 (22.1%) of 167 patients who underwent OPCAB surgery. When QT interval measurements were compared, preoperative and postoperative QT and corrected QT interval (QTc) values were significantly longer in the group with atrial fibrillation. Mean values of preoperative QT were 407.5±27.1 in the poAF (-) group vs. 438.5±48.5 in the poAF (+) group (P<0.001). Mean values of preoperative QTc were 419.1±14.5 in the poAF (-) group vs. 448.5±26.6 in the poAF (+) group (P<0.001). Mean values of postoperative QT were 416.3±48.3 in the poAF (-) group vs. 439.2±45.8 in the poAF (+) group (P=0.005). And mean values of postoperative QTc were 419.8±12.5 in the poAF (-) group vs. 452.0±23.3 in the poAF (+) group (P<0.001).

Conclusion:

QT interval measurement may be a new parameter in predicting poAF development after OPCAB surgery.

Keywords:
Atrial Fibrillation; Coronary Artery Bypass; Coronary Artery Bypass, Off-Pump; Elective Surgical Procedures; Postoperative Complications

Abbreviations, Acronyms & Symbols
ACE-I = Angiotensin-converting enzyme inhibitors		Hct = Hematocrit
AF = Atrial fibrillation		IABP = Intra-aortic balloon pump
ARB = Angiotensin receptor blockers		ICU = Intensive care unit
AUC = Area under the curve		LA = Left atrial
BMI = Body mass index		LVEF = Left ventricular ejection fraction
CABG = Coronary artery bypass grafting		MPV = Mean platelet volume
CI = Confidence interval		NPV = Negative predictive value
COPD = Chronic obstructive pulmonary disease		OPCAB = Off-pump coronary artery bypass grafting
CRP = C-reactive protein		poAF = Postoperative atrial fibrillation
ECG = Electrocardiogram		PPV = Positive predictive value
FEV1 = Forced expiratory volume in the first second		QTc = Corrected QT interval
FVC = Forced vital capacity		RDW = Red cell distribution width
Hb = Hemoglobin		ROC = Receiver operating characteristic

		poAF (-) group	poAF (+) group	P-value
		n=130	n=37	P-value
Age (years)		61.7±10.4	66.7±9.0	0.007^* * Significance levels according to Mann-Whitney U test results.
BMI		27.7±5.0	28.6±4.7	0.331^* * Significance levels according to Mann-Whitney U test results.
Gender, n (%)	Female	24 (18.5)	9 (24.3)	0.429^# # Significance levels according to the Chi-square test results.
Gender, n (%)	Male	106 (81.5)	28 (75.7)
Diabetes mellitus, n (%)	-	73 (56.2)	16 (43.2)	0.165^# # Significance levels according to the Chi-square test results.
Diabetes mellitus, n (%)	+	57 (43.8)	21 (56.8)
Hypertension, n (%)	-	69 (53.1)	16 (43.2)	0.291^# # Significance levels according to the Chi-square test results.
Hypertension, n (%)	+	61 (46.9)	21 (56.8)
Smoking, n (%)	-	67 (51.5)	19 (51.4)	0.984^# # Significance levels according to the Chi-square test results.
Smoking, n (%)	+	63 (48.5)	18 (48.6)
Hyperlipidemia, n (%)	-	46 (35.4)	15 (40.5)	0.566^# # Significance levels according to the Chi-square test results.
Hyperlipidemia, n (%)	+	84 (64.6)	22 (59.5)
COPD, n (%)	-	123 (94.6)	34 (91.9)	0.538^# # Significance levels according to the Chi-square test results.
COPD, n (%)	+	7 (5.4)	3 (8.1)
Myocardial infarction, n (%)	-	92 (70.8)	21 (56.8)	0.108^# # Significance levels according to the Chi-square test results.
Myocardial infarction, n (%)	+	38 (29.2)	16 (43.2)
Beta blocker therapy, n (%)	-	120 (92.4)	32 (86.5)	0.428^# # Significance levels according to the Chi-square test results.
Beta blocker therapy, n (%)	+	10 (7.6)	5 (13.5)
Statin therapy, n (%)	-	42 (32.4)	9 (24.3)	0.527^# # Significance levels according to the Chi-square test results.
Statin therapy, n (%)	+	88 (67.6)	28 (75.7)
ACE-I/ARB therapy, n (%)	-	57 (43.9)	15 (40.6)	0.608^# # Significance levels according to the Chi-square test results.
ACE-I/ARB therapy, n (%)	+	73 (56.1)	22 (59.4)

	poAF (-) group	poAF (+) group	^* * Significance levels according to Mann-Whitney U test results. P-value
	n=130	n=37
Preoperative LVEF	51.8±9.0	48.7±9.1	0.053
Preoperative left atrial diameter	38.2±5.7	40.1±6.0	0.083
Preoperative QT	407.5±27.1	438.5±45.8	< 0.001
Preoperative QTc	419.1±14.5	448.5±26.6	< 0.001
Postoperative QT	416.3±48.3	439.2±45.8	0.005
Postoperative QTc	419.8±12.5	452.0±23.3	< 0.001
Preoperative Hb	13.4±2.0	13.7±2.1	0.577
Preoperative Hct	40,8±5,9	41,3±6,0	0.906
Preoperative RDW	16.3±2.2	16.4±2.7	0.857
Preoperative MPV	8.2±1.6	8.2±1.4	0.740
Preoperative CRP	18.0±29.6	13.0±27.4	0.140
Preoperative troponin I	980.3±3095.1	350.6±849.0	0.900
Postoperative Hb	10.6±1.3	10.9±1.4	0.389
Postoperative Hct	31.6±3.7	32.5±4.7	0.480
Postoperative troponin I	6961.6±13958.9	8311.6±14162.2	0.197

		poAF (-) group	poAF (+) group	P-value
		n=130	n=37	P-value
Heart rate		64.2±6.9	64.3±9.4	0.869^* * Significance levels according to Mann-Whitney U test results.
FEV1/FVC		77.1±10.6	74.9±13.3	0.344^* * Significance levels according to Mann-Whitney U test results.
Bypassed vessel		4.6±1.0	4.5±1.1	0.386^* * Significance levels according to Mann-Whitney U test results.
Transfusion (unit)		2.0±1.4	1.7±1.0	0.444^* * Significance levels according to Mann-Whitney U test results.
Total drainage		579.1±298.1	675.8±279.4	0.034^* * Significance levels according to Mann-Whitney U test results.
Intensive care unit (hours)		69.6±45.0	71.4±42.3	0.623^* * Significance levels according to Mann-Whitney U test results.
Hospital stay (days)		3.3±2.2	3.0±2.0	0.635^* * Significance levels according to Mann-Whitney U test results.
Extubation time (hours)		6.3±3.0	5.9±1.7	0.678^* * Significance levels according to Mann-Whitney U test results.
Postoperative lactate		1.5±0.7	2.3±3.1	0.508^* * Significance levels according to Mann-Whitney U test results.
Transfusion	-	72 (56.3)	22 (59.5)	0.728^# # Significance levels according to the Chi-square test results.
Transfusion	+	56 (43.8)	15 (40.5)
IABP	-	123 (94.6)	35 (94.6)	0.996^# # Significance levels according to the Chi-square test results.
IABP	+	7 (5.4)	2 (5.4)
Inotropic support	-	109 (83.8)	27 (73.0)	0.133^# # Significance levels according to the Chi-square test results.
Inotropic support	+	21 (16.2)	10 (27.0)
Neurologic deficit	-	127 (97.7)	36 (97.3)	0.890^# # Significance levels according to the Chi-square test results.
Neurologic deficit	+	3 (2.3)	1 (2.7)
Mortality	+	2 (1.5)	1 (2.7)	0.638^# # Significance levels according to the Chi-square test results.
Mortality	-	128 (98.5)	36 (97.3)

	Univariate		Multivariate
Variables	Odds ratio (95% CI)	P-value	Odds ratio (95% CI)	P-value
Age	1.062 (1.015-1.111)	0.009	1.013 (0.961-1.069)	0.621
Postoperative QTc	1.147 (1.064-1.238)	0.001	1.093 (1.063-1.122)	0.001
Preoperative QTc	0.973 (0.905-1.045)	0.448
Postoperative QT	0.994 (0.980-1.009)	0.438
Preoperative QT	0.992 (0.968-1.017)	0.540
LVEF	0.979 (0.921-1.041)	0.500
LA diameter	1.095 (0.997-1.203)	0.058
Total drainage	0.999 (0.997-1.002)	0.564

Test results	AUC	Standard error	P-value	Cutoff	Sensitivity	Specificity	95% Confidence interval
Variables	AUC	Standard error	P-value	Cutoff	Sensitivity	Specificity	Lower	Upper
Preoperative QT	0.728	0.057	0.001	419	0.703	0.692	0.617	0.839
Preoperative QTc	0.814	0.057	0.001	434.5	0.784	0.869	0.703	0.925
Postoperative QT	0.651	0.056	0.005	423.5	0.595	0.585	0.541	0.76
Postoperative QTc	0.845	0.051	0.001	431	0.811	0.885	0.744	0.945

		N	Mean	Standard deviation	Min.	Max.	^* * Significance levels according to independent t-test results. P-value
Preoperative QT	AF (+)	130	407,4923	27,11281	290	510	< 0,001
	AF (-)	37	438,5135	45,84431	348	538	< 0,001
	Total	167	414,3653	34,55454	290	538
Preoperative QTc	AF (+)	130	419,1154	14,52271	374	474	< 0,001
	AF (-)	37	448,4865	26,62666	389	491	< 0,001
	Total	167	425,6228	21,61788	374	491
Postoperative QT	AF (+)	130	416,3	48,32363	168	592	0,011
	AF (-)	37	439,2162	45,82463	322	537	0,011
	Total	167	421,3772	48,59218	168	592
Postoperative QTc	AF (+)	130	419,8	12,48093	380	462	<0,001
	AF (-)	37	452	23,29998	401	486	<0,001
	Total	167	426,9341	20,46188	380	486

	Cutoff	Sensitivity % (95% CI)	Sensitivity % (95% CI)	PPV %	NPV %	AUC	P-value
Preoperative QT	419,0	70,3 (59,4-79,3)	69,2 (41,3-87,8)	39,4	89,1	0,728	0,001
Preoperative QTc	434,5	78,4 (68,5-86,1)	86,9 (59,1-96,8)	65,1	9,34	0,814	0,001
Postoperative QT	423,5	59,5 (48,4-69,7)	58,5 (32,1-80,8)	29	83,5	0,651	0,005
Postoperative QTc	431,0	81,1 (71,0-88,3)	88,5 (60,9-97,4)	66,7	94,3	0,845	0,001

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[1] Correspondence Address: Gencehan Kumtepe, https://orcid.org/0000-0002-0041-5834, Department of Cardiovascular Surgery, Meddem Hospital, Çünür, Süleyman Demirel Cd. No: 179, Isparta Merkez, Isparta, Turkey, Zip Code: 32200, E-mail: kumtepe.gencehan@gmail.com