The relationship between postoperative atrial fibrillation after coronary artery bypass surgery and inflammation

Year 2020, Volume: 6 Issue: 5, 409 - 415, 04.09.2020

Burak Erdolu Ahmet Kağan As

https://doi.org/10.18621/eurj.683034

Abstract

Objectives: Postoperative atrial fibrillation (PoAF) may occur up to 50% after coronary artery bypass grafting (CABG) operations. The most important problems related to this are prolonged hospitalizations, thromboembolic cerebrovascular events and new onset heart failure. In this study, we aimed to investigate the relation of high sensitivity C-reactive protein (hsCRP) and heat shock protein 70 (HSP70) levels and occurrence of PoAF in patients undergoing isolated CABG.

Methods: Patients who underwent elective isolated coronary artery bypass surgery between November 2008 and April 2009 in the Cardiovascular Surgery Clinic of Dıskapı Yıldırım Beyazıt Training and Research Hospital were prospectively included in the study.

Results: A total of 40 patients (20 Off-pump CABG (OPCABG), mean age: 59.3 ± 5.56 years) and 20 On-pump CABG (mean age: 60.7 ± 5.3 years)) were included in the study. PoAF ratio was 25% in on-pump CABG patients and 15% in OPCABG group (p = 0.356). Age and diameters of the heart cavities were statistically significantly higher in patients with POAF in both surgical groups. Left ventricular ejection fraction was significantly lower in patients with PoAF. Preoperative hsCRP, postoperative hsCRP, preoperative HSP70 and postoperative HSP70 levels were significantly higher in patients with PoAF who underwent OPCABG (p = 0.018, p = 0.044, p < 0.001 and p = 0.047; respectively).

Conclusions: As a result, PoAF is undesirable for CABG operations. PoAF can be predicted by evaluating HSP70 and hsCRP values before coronary bypass operations. 

Keywords

Coronary artery bypass grafting, postoperative atrial fibrillation, inflammation, heat shock protein 70

References

• 1. Öztürk C, Yavuz Ş. Effect of coronary artery bypass surgery on ventricular functions in patients with poor left ventricular function. Eur Res J 2019;5:502-9.
• 2. Güvenç O, Göncü MT, Engin M, Çayır MÇ, Özyazıcıoğlu AF. Effects of coronary endarterectomy on postoperative early results in long segment coronary artery disease. Eur Res J 2020;6:187-92.
• 3. Ozsin KK, Sanrı US, Toktas F, Kahraman N, Demir D, Yavuz S. Effect of SYNTAX score II on postoperative atrial fibrillation in patients undergoing off-pump coronary artery bypass grafting surgery. Kuwait Med J 2019;51:366-72.
• 4. Erdolu B, As AK, Engin M. The relationship between the HATCH score, neutrophil to lymphocyte ratio and postoperative atrial fibrillation after off-pump coronary artery bypass graf surgery. Heart Surg Forum 2020;23:E88-92.
• 5. Szmitko PE, Wang CH, Weisel RD, de Almeida JR, Anderson TJ, Verma S. New markers of inflammation and endothelial cell activation: Part I. Circulation 2003;108:1917-23.
• 6. Conway DS, Buggins P, Hughes E, Lip GY. Prognostic significance of raised plasma levels of interleukin-6 and C-reactive protein in atrial fibrillation Am Heart J 2004;148:462-6.
• 7. Weymann A, Popov A-F, Sabashnikov A, Ali-Hasan-Al-Saegh S, Ryazanov M, Tse G, et al. Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: a systematic review and metaanalysis. Kardiol Pol 2018;76:440-51.
• 8. Mandal K, Torsney E, Poloniecki J, Camm AJ, Xu Q, Jahangiri M. Association of high intracellular, but not serum, heat shock protein 70 with postoperative atrial fibrillation. Ann Thorac Surg 2005;79:865-71.
• 9. Weymann A, Ali-Hasan-Al-Saegh S, Popov A-F, Sabashnikov A, Mirhosseini SJ, Liu T, et al. Hematologic indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery or combined procedures: a systematic review with meta-analysis. Kardiol Pol 2018;76:107-18.
• 10. Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996;94:390-7.
• 11. Baki ED, Aldemir M, Kokulu S, Koca HB, Ela Y, Sıvacı RG, et al. Comparison of the effects of desflurane and propofol anesthesia on the inflammatory response and s100β protein during coronary artery bypass grafting. Inflammation 2013;36:1327-33.
• 12. Wijeysundera DN, Beattie WS, Djaiani G, Rao V, Borger MA, Karkouti K, et al. Off-pump coronary artery surgery for reducing mortality and morbidity: meta-analysis of randomized and observational studies. J Am Coll Cardiol 2005;46:872-82.
• 13. Bohatch Júnior MS, Matkovski PD, Di Giovanni FJ, Fenili R, Varella EL, Dietrich A. Incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting. Braz J Cardiovasc Surg 2015;30:316-24.
• 14. Lin WS, Liou JT, Yang SP, Tsai CS, Chung MH, Chu KM. Can off-pump coronary artery bypass graft surgery decrease the incidence of postoperative atrial fibrillation? Acta Cardiol Sin 2006;22:205-11.
• 15. Kuller LH, Tracy RP, Shaten J, Meilahn EN. For the MRFIT Research Group: Relation of C- reactive protein and coronary heart disease in the MRFIT nested case-control study. Am J Epidemiol 1996;144:537-47.
• 16. Korantzopoulos P, Kolettis T, Siogas K, Goudevenos J. Atrial fibrillation and electrical remodeling: the potential role of inflammation and oxidative stress. Med Sci Monit 2003;9:RA225-9.
• 17. Ucar HI, Tok M, Atalar E, Dogan OF, Oc M, Farsak B, et al. Predictive significance of plasma levels of interleukin-6 and high-sensitivity C-reactive protein in atrial fibrillation after coronary artery bypass surgery. Heart Surg Forum 2007;10:E131-5.
• 18. Tavaria M, Gabriele T, Kola I, Anderson RL. A Hitchhiker’s guide to the human Hsp70 family. Cell Stress Chaperones 1996;1:23-8.
• 19. Henderson B. Integrating the cell stress response: a new view of molecular chaperones as immunological and physiological homeostatic regulators. Cell Biochem Funct 2010;28:1-14.
• 20. Brundel BJ, Henning RH, Ke L, van Gelder IC, Crijns HJ, Kampinga HH. Heat shock protein upregulation protects against pacing-induced myolysis in HL-1 atrial myocytes and in human atrial fibrillation. J Mol Cell Cardiol 2006;41:555-62.
• 21. Yang M, Tan H, Cheng L, He M, Wei Q, Tanguay RM, et al. Expression of heat shock proteins in myocardium of patients with atrial fibrillation. Cell Stress Chaperones 2007;12:142-50.
• 22. Nisanoglu V, Erdil N, Aldemir M, Ozgur B, Berat Cihan H, Yologlu S, et al. Atrial fibrillation after coronary artery bypass grafting in elderly patients: incidence and risk factor analysis. Thorac Cardiovasc Surg 2007;55:32-8.
• 23. Turk T, Vural H, Eris C, Ata Y, Yavuz S. Atrial fibrillation after off-pump coronary artery surgery: a prospective, matched study. J Int Med Res 2007;35:134-42.
• 24. Geçmen Ç, Babür Güler G, Erdoğan E, Hatipoglu S, Guler E, Yilmaz F, et al. SYNTAX score predicts postoperative atrial fibrillation in patients undergoing on-pump isolated coronary artery bypass grafting surgery. Anatol J Cardiol 2016;16:655-61.
• 25. Huxley RR, Filion KB, Konety S, Alonso A. Meta-analysis of cohort and case-control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011;108:56-62.
• 26. Faustino A, Providencia R, Barra S, Paiva L, Trigo J, Botelho A, et al. Which method of left atrium size quantification is the most accurate to recognize thromboembolic risk in patients with non-valvular atrial fibrillation? Cardiovasc Ultrasound 2014;12:28.