BACKGROUND Postoperative atrial fibrillation (PoAF) is a common complication after cardiac surgery. A pre-existing atrial substrate appears to be important in postoperative development of dysrhythmia, but its preoperative estimation is challenging. We tested the hypothesis that a combination of clinical predictors, noninvasive surrogate markers for atrial fibrosis defining abnormal left atrial (LA) mechanics, and biomarkers of collagen turnover is superior to clinical predictors alone in identifying patients at-risk for PoAF. METHODS In patients without prior AF undergoing coronary artery bypass grafting, concentrations of biomarkers reflecting collagen synthesis and degradation, extracellular matrix, and regulatory microRNA-29s were determined in serum from preoperative blood samples and correlated to atrial fibrosis extent, alteration in atrial deformation properties determined by 3D speckle-tracking echocardiography, and AF development. RESULTS Of 90 patients without prior AF, 34 who developed PoAF were older than non-PoAF patients (72.04 ± 10.7 y; P = 0.043) with no significant difference in baseline comorbidities, LA size, or ventricular function. Global (P = 0.007) and regional longitudinal LA strain and ejection fraction (P = 0.01) were reduced in PoAF vs. non-PoAF patients. Preoperative amino-terminal-procollagen-III-peptide (PIIINP) (103.1 ± 39.7 vs. 35.1 ± 19.3; P = 0.041) and carboxy-terminal-procollagen-I-peptide levels were elevated in PoAF vs. non-PoAF patients with a reduction in miR-29 levels and correlated with atrial fibrosis extent. Combining age as the only significant clinical predictor with PIIINP and miR-29a provided a model that identified PoAF patients with higher predictive accuracy. CONCLUSIONS In patients without a previous history of AF, using age and biomarkers of collagen synthesis and regulation, a noninvasive tool was developed to identify those at risk for new-onset PoAF.

中文翻译：

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基于无创生物标志物的风险分层，用于冠状动脉搭桥手术后新发心房颤动的发展。

背景术后心房颤动（PoAF）是心脏手术后常见的并发症。预先存在的心房基质似乎在心律失常的术后发展中很重要，但其术前估计具有挑战性。我们检验了以下假设，即临床预测因子、定义异常左心房 (LA) 力学的心房纤维化非侵入性替代标志物和胶原蛋白更新的生物标志物在识别有 PoAF 风险的患者方面优于单独的临床预测因子。方法 在没有既往 AF 且接受冠状动脉旁路移植术的患者中，在术前血液样本的血清中测定反映胶原合成和降解的生物标志物、细胞外基质和调节性 microRNA-29 的浓度，并与心房纤维化程度相关联。由 3D 斑点追踪超声心动图和 AF 发展确定的心房变形特性的改变。结果 在 90 名既往无 AF 的患者中，34 名发生 PoAF 的患者年龄大于非 PoAF 患者（72.04 ± 10.7 岁；P = 0.043），基线合并症、LA 大小或心室功能无显着差异。PoAF 与非 PoAF 患者的整体 (P = 0.007) 和局部纵向 LA 应变和射血分数 (P = 0.01) 降低。PoAF 与非 PoAF 患者术前氨基末端前胶原-III-肽 (PIIINP) (103.1 ± 39.7 vs. 35.1 ± 19.3; P = 0.041) 和羧基末端-前胶原-I-肽水平升高miR-29 水平的降低与心房纤维化程度相关。将年龄作为唯一重要的临床预测因子与 PIIINP 和 miR-29a 相结合，提供了一个模型，该模型以更高的预测准确性识别出 PoAF 患者。结论 在既往没有 AF 病史的患者中，使用年龄和胶原合成和调节的生物标志物，开发了一种非侵入性工具来识别有新发 PoAF 风险的患者。