Impact of Chronic Kidney Disease Classification on New-Onset Atrial Fibrillation in the General Population　― The TAMA MED Project-AF and CKD ―

Abstract Background The prevalence of left atrial enlargement (LAE) and fragmented QRS (fQRS) diagnosed using ECG criteria in patients with severe chronic kidney disease (CKD) is unknown. Furthermore, there is limited data on predicting new-onset atrial fibrillation (AF) with LAE or fQRS in this patient group. Methods We enrolled 165 consecutive non-dialysis patients with CKD stage 4–5 without prior AF diagnosis between 2013 and 2017 in a prospective follow-up cohort study. LAE was defined as total P-wave duration ≥120 ms in lead II ± > 1 biphasic P-waves in leads II, III or aVF; or duration of terminal negative portion of P-wave > 40 ms or depth of terminal negative portion of P-wave > 1 mm in lead V1 from a baseline ECG, respectively. fQRS was defined as the presence of a notched R or S wave or the presence of ≥1 additional R waves (R’) or; in the presence of a wide QRS complex (> 120 ms), > 2 notches in R or S waves in two contiguous leads corresponding to a myocardial region, respectively. Results Mean age of the patients was 59 (SD 14) years, 56/165 (33.9%) were female and the mean estimated glomerular filtration rate was 12.8 ml/min/1.73m2. Altogether 29/165 (17.6%) patients were observed with new-onset AF within median follow-up of 3 [IQR 3, range 2–6] years. At baseline, 137/165 (83.0%) and 144/165 (87.3%) patients were observed with LAE and fQRS, respectively. Furthermore, LAE and fQRS co-existed in 121/165 (73.3%) patients. Neither findings were associated with the risk of new-onset AF within follow-up. Conclusion The prevalence of LAE and fQRS at baseline in this study on CKD stage 4–5 patients not on dialysis was very high. However, LAE or fQRS failed to predict occurrence of new-onset AF in these patients.

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Preexisting Chronic Kidney Disease and Dyslipidemia are Strong Predictors for Early Acute Cerebrovascular Event After Isolated Coronary Artery Bypass Grafting: A Single Cardiac Center Experience

ASEAN Heart Journal ◽

10.31762/ahj2029.0102 ◽

2020 ◽

Vol 29 (1) ◽

pp. 8-13

Author(s):

Leonardo Paskah Suciadi ◽

Andreas Hartanto Santoso ◽

Irvan Cahyadi ◽

Hoo Felicia Davina Hadi Gunawan ◽

Joshua Henrina Sudjaja ◽

...

Keyword(s):

Atrial Fibrillation ◽

Chronic Kidney Disease ◽

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Kidney Disease ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Grafting ◽

Onset Atrial Fibrillation ◽

New Onset

The outcomes of coronary artery bypass grafting (CABG) surgery are determined by numerous factors. This study aimed to analyze the factors contributing to short-term outcomes of patients undergoing isolated CABG. This retrospective analysis enrolled all adult patients undergoing isolated CABG at our center between January 2013 and December 2016. Clinical characteristics and postoperative events were recorded and analyzed. Overall, 242 patients (mean age, 59.7 ± 9.5 years) were included. The majority of the patients (88.4%) were men. The median left ventricular ejection fraction (LVEF) was 50% ± 15%, with 38% patients having an LVEF lower than 40% and 9.1% having an LVEF lower than 25%. The mean preoperative creatinine level was 1.25 ± 0.73, and the estimated glomerular filtration rate was 68.55 ± 23 ml/min/1.73 m2. The intensive cardiac care unit stay and total in-hospital stay were 70 ± 59 h and 8 ± 4 days, respectively. The in-hospital mortality rate was 2.1%. The most common major adverse events were new-onset atrial fibrillation (31.8%) and significant worsening of renal function (21.5%). Stroke occurred in 3.7% patients, for which preexisting chronic kidney disease (CKD) and dyslipidemia were strong predictors (P < 0.05; area under the curve [AUC], 87.7%). Advanced age and hypertension were considered significant risk factors for developing new-onset atrial fibrillation (P < 0.05; AUC 65%). Worsening renal function and new-onset atrial fibrillation were the most frequent complications that occurred during hospitalization following CABG. Preexisting CKD and dyslipidemia were the major risk factors for developing acute stroke post surgery. KEYWORDS Acute cerebrovascular events, Chronic kidney disease, Coronary artery bypass grafting, Dyslipidemia.

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