Plasma big endothelin-1 predicts new-onset atrial fibrillation after surgical septal myectomy in patients with hypertrophic cardiomyopathy

摘要

Postoperative atrial fibrillation (POAF) is a common complication in patients with obstructive hypertrophic cardiomyopathy (HOCM) who undergo surgical myectomy. POAF is associated with poor outcome. The role of plasma big endothelin-1 level in predicting atrial fibrillation after surgical septal myectomy in HOCM patients has not well been studied. A total of 118 patients with HOCM who underwent surgical septal myectomy were recruited in this study. Plasma big endothelin-1 level was measured. The heart rhythm was continuously monitored during hospital stay. Preoperative, intraoperative, and postoperative variables were collected. POAF developed among 26 of the 118 patients (22%) in this study. Compared with those without POAF, patients with POAF were significantly older (53.5?±?10.6 vs. 47.3?±?13.6?years, P?=?0.033), more likely to undergo mitral valve surgery (38.5% vs. 18.5%, P?=?0.032), and had higher plasma big endothelin-1 levels (0.41?±?0.19 vs. 0.27?±?0.14?pmol/l, P?=?0.001), longer hospital stay (9.1?±?3.7 vs. 7.5?±?2.8?days, P?=?0.022), larger preoperative left atria (48.0?±?5.2 vs. 44.1?±?5.9?mm; P?=?0.003). In the receiver operating characteristic curve analysis, the area under the curve for big endothelin-1 was 0.734 (95% CI, 0.634 to 0.834, P0.001). In multivariate logistic regression analysis, preoperative big endothelin-1 level (OR 100.7, 95%CI: 5.0–2020.0, P?=?0.003) and left atrial diameter (OR 1.106, 95%CI: 1.015–1.205, P?=?0.022) were independent predictors of POAF. Elevated preoperative plasma big endothelin-1 level is an independent predictor of POAF in HOCM patients undergoing surgical septal myectomy.