Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: Role beyond the CHA2DS2-VASc score

Su Kiat Chua, Kou Gi Shyu, Ming Jen Lu, Huei Fong Hung, Jun Jack Cheng, Chiung Zuan Chiu, Chia Hsun Lin, Hung Hsing Chao, Huey Ming Lo

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Aims To investigate whether renal dysfunction is a useful predictor of postoperative atrial fibrillation (POAF) after cardiac surgery. We also aimed to determine whether the addition of renal dysfunction into the scoring system could improve diagnostic accuracy of the CHA2DS2-VASc score to predict POAF. Methods and results The study prospectively enrolled 350 consecutive patients who underwent cardiac surgery. Echocardiography was performed before cardiac surgery. Renal dysfunction was defined as estimated glomerular filtration rate <60 mL min-1 1.73 m-2. All patients were monitored with continuous electrocardiographic telemetry for the occurrence of POAF until the day of hospital dismissal. Postoperative atrial fibrillation occurred in 103 of 350 patients (29%). Patients with POAF was associated with longer intensive care unit stay compared with those without POAF (3.7 ± 2.2 vs. 3.1 ± 1.4 days, P = 0.002). Both the CHA2DS2-VASc score and renal dysfunction were independent predictors of POAF in multivariate analysis. Renal dysfunction can further stratify patients with a CHA2DS2-VASc score of 0 or 1 into two groups with different POAF rates (3.1% vs. 68.8%, P <0.001). A new scoring system (R-CHA2DS2-VASc score) derived by assigning an additional point representing renal dysfunction to the CHA2DS2-VASc score could improve its predictive accuracy. The area under the receiver operating characteristic curve increased from 0.68 to 0.71 (P <0.001). Furthermore, the rate of left ventricular diastolic dysfunction also increased with increasing renal dysfunction. Conclusion Renal dysfunction, associated with left ventricular diastolic dysfunction, was a significant risk factor for POAF after cardiac surgery and may improve the diagnostic accuracy of the CHA2DS2-VASc score.

Original languageEnglish
Pages (from-to)1363-1370
Number of pages8
JournalEuropace
Volume17
Issue number9
DOIs
Publication statusPublished - Jul 29 2015

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Atrial Fibrillation
Thoracic Surgery
Kidney
Left Ventricular Dysfunction
Telemetry
Glomerular Filtration Rate
ROC Curve
Intensive Care Units
Echocardiography
Multivariate Analysis

Keywords

  • Atrial fibrillation
  • CABG
  • CHADS-VASc
  • Renal function

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Chua, S. K., Shyu, K. G., Lu, M. J., Hung, H. F., Cheng, J. J., Chiu, C. Z., ... Lo, H. M. (2015). Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: Role beyond the CHA2DS2-VASc score. Europace, 17(9), 1363-1370. https://doi.org/10.1093/europace/euu360

Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery : Role beyond the CHA2DS2-VASc score. / Chua, Su Kiat; Shyu, Kou Gi; Lu, Ming Jen; Hung, Huei Fong; Cheng, Jun Jack; Chiu, Chiung Zuan; Lin, Chia Hsun; Chao, Hung Hsing; Lo, Huey Ming.

In: Europace, Vol. 17, No. 9, 29.07.2015, p. 1363-1370.

Research output: Contribution to journalArticle

Chua, SK, Shyu, KG, Lu, MJ, Hung, HF, Cheng, JJ, Chiu, CZ, Lin, CH, Chao, HH & Lo, HM 2015, 'Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery: Role beyond the CHA2DS2-VASc score', Europace, vol. 17, no. 9, pp. 1363-1370. https://doi.org/10.1093/europace/euu360
Chua, Su Kiat ; Shyu, Kou Gi ; Lu, Ming Jen ; Hung, Huei Fong ; Cheng, Jun Jack ; Chiu, Chiung Zuan ; Lin, Chia Hsun ; Chao, Hung Hsing ; Lo, Huey Ming. / Renal dysfunction and the risk of postoperative atrial fibrillation after cardiac surgery : Role beyond the CHA2DS2-VASc score. In: Europace. 2015 ; Vol. 17, No. 9. pp. 1363-1370.
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abstract = "Aims To investigate whether renal dysfunction is a useful predictor of postoperative atrial fibrillation (POAF) after cardiac surgery. We also aimed to determine whether the addition of renal dysfunction into the scoring system could improve diagnostic accuracy of the CHA2DS2-VASc score to predict POAF. Methods and results The study prospectively enrolled 350 consecutive patients who underwent cardiac surgery. Echocardiography was performed before cardiac surgery. Renal dysfunction was defined as estimated glomerular filtration rate <60 mL min-1 1.73 m-2. All patients were monitored with continuous electrocardiographic telemetry for the occurrence of POAF until the day of hospital dismissal. Postoperative atrial fibrillation occurred in 103 of 350 patients (29{\%}). Patients with POAF was associated with longer intensive care unit stay compared with those without POAF (3.7 ± 2.2 vs. 3.1 ± 1.4 days, P = 0.002). Both the CHA2DS2-VASc score and renal dysfunction were independent predictors of POAF in multivariate analysis. Renal dysfunction can further stratify patients with a CHA2DS2-VASc score of 0 or 1 into two groups with different POAF rates (3.1{\%} vs. 68.8{\%}, P <0.001). A new scoring system (R-CHA2DS2-VASc score) derived by assigning an additional point representing renal dysfunction to the CHA2DS2-VASc score could improve its predictive accuracy. The area under the receiver operating characteristic curve increased from 0.68 to 0.71 (P <0.001). Furthermore, the rate of left ventricular diastolic dysfunction also increased with increasing renal dysfunction. Conclusion Renal dysfunction, associated with left ventricular diastolic dysfunction, was a significant risk factor for POAF after cardiac surgery and may improve the diagnostic accuracy of the CHA2DS2-VASc score.",
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AU - Hung, Huei Fong

AU - Cheng, Jun Jack

AU - Chiu, Chiung Zuan

AU - Lin, Chia Hsun

AU - Chao, Hung Hsing

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AB - Aims To investigate whether renal dysfunction is a useful predictor of postoperative atrial fibrillation (POAF) after cardiac surgery. We also aimed to determine whether the addition of renal dysfunction into the scoring system could improve diagnostic accuracy of the CHA2DS2-VASc score to predict POAF. Methods and results The study prospectively enrolled 350 consecutive patients who underwent cardiac surgery. Echocardiography was performed before cardiac surgery. Renal dysfunction was defined as estimated glomerular filtration rate <60 mL min-1 1.73 m-2. All patients were monitored with continuous electrocardiographic telemetry for the occurrence of POAF until the day of hospital dismissal. Postoperative atrial fibrillation occurred in 103 of 350 patients (29%). Patients with POAF was associated with longer intensive care unit stay compared with those without POAF (3.7 ± 2.2 vs. 3.1 ± 1.4 days, P = 0.002). Both the CHA2DS2-VASc score and renal dysfunction were independent predictors of POAF in multivariate analysis. Renal dysfunction can further stratify patients with a CHA2DS2-VASc score of 0 or 1 into two groups with different POAF rates (3.1% vs. 68.8%, P <0.001). A new scoring system (R-CHA2DS2-VASc score) derived by assigning an additional point representing renal dysfunction to the CHA2DS2-VASc score could improve its predictive accuracy. The area under the receiver operating characteristic curve increased from 0.68 to 0.71 (P <0.001). Furthermore, the rate of left ventricular diastolic dysfunction also increased with increasing renal dysfunction. Conclusion Renal dysfunction, associated with left ventricular diastolic dysfunction, was a significant risk factor for POAF after cardiac surgery and may improve the diagnostic accuracy of the CHA2DS2-VASc score.

KW - Atrial fibrillation

KW - CABG

KW - CHADS-VASc

KW - Renal function

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