In the present study we aimed at determining the predictors of POAF in patients with rheumatic MVD schedualed for mitral valve replacement to avoid over use of anti arrhythmic drugs with their unwanted side effects.
This study included 50 patients scheduled for mitral valve replacement their age ranged from 30-61 years . They were assessed for baseline characteristics, admission data, ECG (pre&post-operative ), conventional echocardiographic parameters ,TDI, LA strain% and LV global longitudinal strain (GLS%). They were classified into 2 groups , group I representing patients who developed POAF and group II representing patients who remained sinus in rhythm post -operatively.
Patients who developed POAF were older with more patients with diabetes , hypertension and dyslipidemia .βeta –blockers , statins were more used by the patients of group I but ACE inhibitors did not show significant difference between the 2 groups.
Patients of group I had greater heart rate, diastolic blood pressure and body mass index but there was not significant difference between the 2 groups regarding systolic blood pressure .
Conventional echocardiographic data showed that patients of group I had greater left atrial (LA) diameters (antero-postarior, transverse& longitudinal diameters) , greater left atrial(LA)volumes (maximal & minimal volumes) and greater left ventricular end-systolic volume (LVESV),greater pulmonary artery systolic pressure (PASP) but lower left ventricular ejection fraction ( LV EF% ) and there was no significant difference between the 2 groups as regards left atrial emptying fraction (LAEF%) and left ventricular end diastolic volume (LVEDV).
Pulsed wave tissue Doppler imaging (TDI) showed that patients of group I had significantly lower(E`) wave velocity and (A`) wave velocity while having greater(E /E`)ratio but there was no significant difference between the 2 groups regarding (S`)wave velocity. Systolic LA strain and left ventricular global longitudinal strain (LVGLS%)were significantly reduced in group I.
There was no significant difference between the 2 groups regarding DCA results . On comparing the peri-operative data between the 2 groups ,group I showed significantly increased risk of mortality& morbidity by (STS ) score , more patients of group I had tricuspid valve repair.
Cardio-pulmonary bypass , cross-clamping time, ventilator time and ICU duration were significantly greater in group I. Inotropic support (dopamine and /or adrenaline ) were more prevalent in group I . There was no significant difference between the 2 groups regarding post-operative complications (PPM , I.E and thrombosis).
Several variables in multi variant analysis were associated with POAF including age , diabetes ,diastolic blood pressure ,heart rate , LA strain % & LVGLS % .
The receiver-operator characteristic (ROC) curve was used to test diagnostic value of LA strain% and LVGLS % and revealed that , LA strain %≤ 23 was shown to have the best diagnostic accuracy(sensitivity = 90.91%; specificity = 93.33%) with an AUC of 0.9811, while LVGLS% ≤ -14.9 has good diagnostic accuracy (sensitivity = 63.6%; specificity = 100.0%) in predicting the presence of POAF , with an AUC of 0.8182 .
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