Peak atrial longitudinal strain as a predictor of postoperative atrial fibrillation in isolated coronary artery bypass grafting: Insights from a single-centre study in Indonesia

Abstract

Background: Postoperative atrial fibrillation (POAF) is a frequent complication in patients undergoing coronary artery bypass grafting (CABG) and contributes to increased morbidity and mortality. Identifying accurate preoperative predictors for POAF remains a clinical challenge.

Objectives: This study aimed to evaluate the predictive value of preoperative peak atrial longitudinal strain (PALS) for POAF in patients undergoing isolated CABG.

Methods: This prospective cohort study was conducted from May to October 2024. A total of 58 adult patients undergoing isolated CABG were consecutively enrolled. PALS measurement was performed preoperatively using speckle tracking echocardiography. Patients were followed for 30 days postoperatively to monitor POAF occurrence. Statistical analyses in this study included ROC curve, Kaplan-Meier, and Cox regression.

Results: Of the 58 patients, 30 patients had PALS <28% and 28 patients had PALS ≥28%. The incidence of POAF was significantly higher in the low PALS group (53.3% vs 10.7%, p=0.001). Multivariate analysis showed that low PALS, high BMI, and on-pump CABG were independent predictors of POAF. We also revealed that the combination of low PALS and on-pump CABG technique conferred the highest risk of POAF. Kaplan-Meier analysis reinforced that the cumulative incidence of POAF was higher in patients with low PALS and those undergoing on-pump CABG.

Conclusion: Preoperative PALS <28% is a strong predictor of POAF in patients undergoing isolated CABG. PALS assessment and surgical technique can optimize risk stratification and POAF prevention strategies.