Predictive Value of Preoperative Left Atrial Coupling Indices for Postoperative Atrial Fibrillation After Isolated CABG

TL;DR

This study shows that a new echocardiographic measure, LACI2, better predicts atrial fibrillation after heart surgery than an older version.

Contribution

The novel LACI2 calculation method shows improved predictive performance for postoperative atrial fibrillation compared to LACI1.

Findings

LACI1 and LACI2 were significantly higher in patients who developed postoperative atrial fibrillation.

LACI2 demonstrated numerically higher discriminatory performance (AUC = 0.690) compared to LACI1 (AUC = 0.677).

Abstract

Background and Objectives: Postoperative atrial fibrillation (POAF) is the most common arrhythmia after coronary artery bypass grafting (CABG) and is linked to adverse outcomes. This study evaluated the predictive value of the Left Atrial Coupling Index (LACI) for POAF and compared two calculation methods, LACI1 and the novel LACI2. Materials and Methods: This prospective study included 130 patients undergoing isolated CABG between January 2022 and June 2023. Preoperative echocardiography was performed to calculate conventional parameters and LACI values: LACI1 = LAVI/TDI-septal a′ and LACI2 = LAVI/min (TDI-septal a′, TDI-lateral a′). Patients were classified into POAF (+) and POAF (−) groups. Clinical, echocardiographic, and outcome data were compared. Logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: POAF occurred in 59 patients (45.4%). Those with POAF were older, had more diabetes mellitus(DM), hypertension(HT), and higher EuroSCORE II values (all p < 0.05). POAF was associated with longer hospitalization and higher in-hospital mortality. Both LACI1 (4.21 ± 2.62 vs. 2.94 ± 1.02, p < 0.001) and LACI2 (4.27 ± 2.60 vs. 2.96 ± 1.02, p < 0.001) were significantly higher in the POAF group. In multivariate analysis, LACI1 (OR 1.45, p = 0.020) and LACI2 (OR 1.50, p = 0.004) remained independent predictors. ROC analysis showed numerically higher discriminatory performance for LACI2 (AUC = 0.690, specificity 74.5%) compared with LACI1 (AUC = 0.677, specificity 67.6%). Conclusions: LACI is an independent predictor of POAF after CABG. The novel LACI2 demonstrated numerically higher predictive performance compared with LACI1 and may improve preoperative risk stratification and guide preventive strategies.

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