Frontal plane QRS-T angle may be a predictor for post-coronary artery bypass graft surgery atrial fibrillation

SUMMARY BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common arrhythmia following coronary artery bypass graft surgery (CABG) and is associated with prolonged hospitalization, stroke, and mortality. The frontal plane QRS-T [f(QRS-T)] angle, which is defined as the angle between the directions of ventricular depolarization (QRS-axis) and repolarization (T-axis), is a novel marker of ventricular repolarization heterogeneity. The f(QRS-T) angle is associated with adverse cardiac outcomes. In light of these findings, in this study, we aimed to investigate the potential relationship between the f(QRS-T) angle and POAF. METHODS: 180 patients who underwent CABG between August 2017 and September 2018 were included in the study retrospectively. Two groups were established as patients who preserved postoperative sinus rhythm (n=130) and those who developed POAF (n=50). The f(QRS-T) angle and all other data were compared between groups. RESULTS: The fF(QRS-T) angle (p<0.001), SYNTAX score (p=0.039), serum high-sensitivity CRP levels (p=0.026), mean age (p<0.001), electrocardiographic left ventricular hypertrophy rate (LVH) (p=0.019), and hypertension rate (p=0.007) were higher, and the mean left ventricular ejection fraction (LVEF) (p<0.001) was lower in the POAF group. Multivariable logistic regression analyses demonstrated that lower LVEF (p=0.004), LVH (p=0.041), and higher age (p=0.008) and f(QRS-T) angle (p<0.001) were independently associated with POAF. CONCLUSIONS: High f(QRS-T) angle level is closely associated with the development of POAF. The f(QRS-T) angle can be a potential indicator of POAF.

Download Full-text

Coronary Artery Bypass Surgery without Cardioplegia: Early Results

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230000800203 ◽

2000 ◽

Vol 8 (2) ◽

pp. 103-108

Author(s):

Poo Sing Wong ◽

Simon Vendargon ◽

Choon Gek Lim

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Artery Bypass ◽

Bypass Graft ◽

Left Ventricular ◽

Operating Conditions ◽

Left Ventricular Ejection ◽

Artery Bypass Graft

From November 1996 to April 1999, 348 patients underwent isolated non-cardioplegic coronary artery bypass grafting at a new center. There were 123 (35%) patients aged over 60 years, 48 (14%) were female, 70 (20%) had a left ventricular ejection fraction below 0.3. Coronary artery bypass graft surgery was performed using hypothermic intermittent ischemic fibrillatory arrest of the heart. The left internal mammary artery was used in 97% of cases. Mean grafts per patient was 3.5. Sixty-three patients (18%) underwent 65 coronary endarterectomies. The overall operative mortality rate was 2.3% (8/348). Follow-up was 97% complete. Mean follow-up was 14.9 ± 8 months (range, 1 to 30 months). Freedom from angina was 98.3% at 6 months, 97% at 12 months, and 97% at 24 months. The overall survival was 96.7% at 6 months, 95.8% at 12 months, and 94.4% at 24 months. It was concluded that this method of myocardial protection for isolated coronary artery bypass graft surgery provided excellent operating conditions in this group of patients.

Download Full-text

222 Prognostic value of high-sensitivity cardiac troponin I early after coronary artery bypass graft surgery

European Heart Journal Supplements ◽

10.1093/eurheartj/suab140.027 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Samuele Nanni ◽

Anna Corsini ◽

Mattia Garofalo ◽

Matteo Schinzari ◽

Elena Nardi ◽

...

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Cardiac Troponin ◽

Artery Bypass ◽

Bypass Graft ◽

High Sensitivity ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Artery Bypass Graft

Abstract Aims The diagnosis of periprocedural myocardial infarction (PMI) after coronary artery bypass graft (CABG) is based on biochemical markers along with clinical and/or instrumental findings. However, there is not a clear cut-off value of high-sensitivity cardiac troponin (hs-cTn) to identify PMI. We hypothesized that isolated hs-cTn concentrations in the first 24 h following CABG could predict cardiac adverse events (in-hospital death and PMI) and/or left ventricular ejection fraction (LVEF) decrease. Methods and results We retrospectively enrolled all consecutive adult patients undergoing CABG at our Institution over 1 year. Hs-cTnI concentrations (Access assay, Beckman-Coulter) were serially measured in the post-operative period and correlated with post-operative outcomes. 300 patients were enrolled; 71.3% of them underwent CABG alone, mainly on-pump (96.7%), 33.7% in the setting of an acute coronary syndrome. Most patients showed hs-cTnI values superior to the limit required by the latest guidelines for the diagnosis of PMI. Five patients (1.7%) died, 8% developed a PMI, and 10.6% showed a LVEF decrease ≥10%. Hs-cTnI concentrations did not correlate with death or PMI whereas they did correlate with LVEF decrease ≥ 10% (P-value < 0.05 at any time interval). Indeed, higher hs-cTnI values at 9–12 h post-operatively, along with previous cardiac surgery, number of surgical procedures, longer cardiopulmonary bypass time, and PMI diagnosis were predictors of LVEF decrease. Conclusions After CABG surgery, hs-cTnI at 9–12 h post-operatively may be a useful method to early identify patients at risk for LVEF decrease and to guide early investigation and management of possible post-operative complications.

Download Full-text