1. Echocardiographic predictors of perioperative atrial fibrillation EUROECHO 2010, Copenhagen, Denmark Katova T, Simova I, Nesheva A, Hristova K, Kostova V, Boiadjiev L, Dimitrov N Department of Noninvasive Cardiovascular Imaging and Functional Diagnostics, National Cardiology Hospital, Sofia, Bulgaria Background Purpose Results Conclusions References 1.Dunning J, Treasure T, Versteegh M, et al. Guidelines on the prevention and management of de novo atrial fibrillation after cardiac and thoracic surgery. Eur J Cardiothorac Surg 2006; 30:852-72. The purpose of our study was to evaluate different echocardiographic parameters and to determine their predictive power for the occurrence of perioperative AF. Atrial fibrillation (AF) is the most common complication in the perioperative period of patients undergoing coronary artery bypass graft (CABG) surgery. Its prevalence ranges between 30 and 40% and it increases considerably the cost of treatment and lengthens the in- hospital stay 1. The prevalence of PO AF in our group was relatively low – 6 patients (19%). We evaluated the relationship of the occurrence of PO AF and different clinical parameters; none of them showed a significant difference between patients with and without occurrence of PO AF. From the echocardiographic parameters, evaluated preoperatively, only IAA time differed significantly between the two groups of patients (table 1). Values of IAA time ≥ 33 ms showed 100% sensitivity and 69% specificity for the occurrence of PO AF according to the ROC (receiver operating characteristic) curve (fig. 2). In a group of patients with a relatively low prevalence of perioperative AF the only echocardiographic parameter correlating significantly with the occurrence of AF in the early postoperative period was interatrial dyssynchrony on tissue Doppler imaging. Evaluating a larger group of patients could help us define a cut-off point for IAA, above which developing perioperative AF is highly likely and administering prophylactic antiarrhythmic therapy is justified. Printed by Fig. 1 IMT measurement AB Methods We studied 32 patients (age 62 ± 10 y) without previous history of AF undergoing elective CABG. Preoperatively the following echocardiographic parameters were studied: left and right artial volume index by two-plane area-length method, left ventricular enddiastolic diameter, ejection fraction, tissue velocities at the mitral and tricuspid annulus during early and late diastolic filling (Em, Am, Et and At, respectively), the time from the onset of P wave on the surface ECG to the onset of A wave on the tissue velocity curve for the lateral segments of the mitral and tricuspid annulus (P-Am and P-At, respectively), the interatrial asynchrony time (IAA) measured as (P-Am) – (P-At) (fig. 1). Address for correspondence: Iana Simova, Department of Noninvasive Cardiovascular Imaging and Functional Diagnostics, National Cardiology Hospital, 65 Koniovitsa Str, Sofia 1309; Bulgaria; email: ianasimova@gmail.comianasimova@gmail.com Fig. 1: Measurement of interatrial asynchrony (IAA) – IAA = time (A) – time (B) Fig. 2: ROC curve ParameterAFno AFp value LAVI ml/m 2 39 ± 1132 ± 110.2 RAVI ml/m 2 23 ± 519 ± 70.2 LVEDD mm52 ± 751 ± 60.9 EF %68 ± 659 ± 120.1 Em cm/s9 ± 3 0.7 Am cm/s11 ± 210 ± 30.7 Et cm/s11 ± 310 ± 30.6 At cm/s15 ± 414 ± 40.8 IAA ms40 ± 623 ± 14< 0.001 Table 1: Echocardiographic parameters in patients with and without AF