The utility of mean platelet volume as a predictor of postoperative atrial fibrillation following coronary artery bypass grafting

Abstract

Aim: Atrial fibrillation is the most common arrhythmia following coronary artery bypass grafting (CABG). The predictors of postoperative atrial fibrillation (POAF) following CABG are controversial. The aim of this study was to evaluate the predictivity of mean platelet volume (MPV) in the development of atrial fibrillation following CABG and other risk factors affecting POAF. 

Methods: A total of 227 patients who underwent on-pump CABG in the cardiovascular surgery department of our hospital between May 2016 and January 2019 were included in this retrospective cohort study. Patients were divided into two groups as those who underwent POAF and those who did not (non-POAF group). Patients’ demographic data such as age, gender, height, weight and BMI, biochemical parameters, comorbidities, smoking status, ejection fraction, the number of bypassed vessels, the use of intra-aortic balloon pump and inotropic agents, total drainage, neurological and other complications, operation time, duration of admission in intensive care unit and in the ward, and mortality status were recorded and comparatively analyzed. 

Results: No statistically significant differences were found between the groups in terms of gender, body mass index, the incidences of diabetes mellitus, hypertension, chronic obstructive pulmonary disease, pulmonary arterial hypertension, renal failure, smoking status, the number of bypassed vessels, the use of intra-aortic balloon pump, inotropic agents, and biochemical parameters (P<0.05 for all) except red cell distribution width (RDW), urea and mean platelet volume (MPV). MPV, RDW and urea values were significantly higher in the POAF group (P=0.004, P=0.018 and P=0.006, respectively). Multivariate regression analysis revealed that age, MPV and the amount of total drainage were independent risk factors for developing POAF (OR=1.080, OR=1.371, OR=1.001; P=0.001, P<0.001, P=0.024, respectively).

Conclusion: MPV can be used as a predictor for the development of POAF following on-pump CABG. MPV is a quite simple parameter, which can be readily obtained in routine complete blood count. However, our results should be supported by further prospective, multicenter and large-scale studies.

Keywords

• Postoperative atrial fibrillation,Mean platelet volume,Coronary artery bypass grafting,Biochemical parameters

Koroner arter baypas greftleme sonrası postoperatif atriyal fibrilasyonun bir prediktörü olarak ortalama trombosit hacminin kullanımı

Öz

Amaç: Atriyal fibrilasyon koroner arter baypas greftleme (KABG) sonrası en sık görülen aritmidir. CABG'yi takiben postoperatif atriyal fibrilasyonun (POAF) belirleyicileri tartışmalıdır. Bu çalışmanın amacı, CABG'yi takiben POAF gelişimi ve POAF'ı etkileyen diğer risk faktörleri için ortalama trombosit hacminin (MPV) kullanımını değerlendirmektir.

Yöntemler: Bu retrospektif kohort çalışmamıza Mayıs 2016-Ocak 2019 tarihleri arasında hastanemizin kardiyovasküler kliniğinde pompalı CABG uygulanan toplam 227 hasta dahil edildi. Hastalar, POAF ve POAF olmayan gruplar olarak iki gruba ayrıldı. Hastaların yaş, cinsiyet, boy, kilo ve BMI gibi demografik verileri, biyokimyasal parametreler, komorbiditeler, sigara içme durumu, ejeksiyon fraksiyonu, baypas edilen damar sayısı, aort içi balon pompası (IABP) ve inotropik ajanlar, toplam drenaj, nörolojik ve diğer komplikasyonlar, operasyon süresi, yoğun bakım ünitesinde ve koğuşta yatış süresi ve mortalite durumu kaydedildi ve karşılaştırmalı olarak analiz edildi.

Bulgular: Gruplar arasında cinsiyet, vücut kitle indeksi, diabetes mellitus insidansı, hipertansiyon, kronik obstrüktif akciğer hastalığı, pulmoner arteriyel hipertansiyon, böbrek yetmezliği, sigara içme durumu, baypas edilen damar sayısı, IABP, inotropik ajanlar ve biyokimyasal parametreler (kırmızı hücre dağılım genişliği (RDW), üre ve MPV hariç anlamlı bir fark bulunmadı. MPV, RDW ve üre değerleri POAF grubunda POAF olmayanlara göre istatistiksel olarak anlamlı derecede yüksekti (sırasıyla P=0,004, P=0,018 ve P=0,006). Çok değişkenli regresyon analizinde, yaş ve toplam drenaj miktarı POAF gelişiminin bağımsız risk faktörleri olarak bulundu (sırasıyla OR=1,080, OR=1,371, OR=1,001; P=0,001, P<0,001, P=0,024).

Sonuç: MPV, pompalı CABG'yi takiben POAF gelişimi için bir belirteç olarak kullanılabilir. MPV, rutin tam kan sayımında kolayca elde edilebilen oldukça basit bir parametredir. Ancak, sonuçlarımız prospektif, çok merkezli ve büyük ölçekli çalışmalarla desteklenmelidir.

Anahtar Kelimeler

• Postoperatif atriyal fibrilasyon,Ortalama trombosit hacmi,Koroner arter baypas greftleme,Biyokimyasal parametreler

Kaynakça

1. 1. Maisel WH, Rawn JD, Stevenson WG. Atrial fibrillation after cardiac surgery. Ann Intern Med. 2001;135:1061-73.
2. 2. Erdem K, Ayhan S, Ozturk S, Bugra O, Bozoglan O, Dursin H, et al. Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting. Platelets. 2014;25:23-6.
3. 3. Yuksel A, Velioglu Y, Tecimer ME, Kan II, Bicer M, Gurbuz O, et al. Is there any relationship of postoperative atrial fibrillation with the use of blood products and postoperative hemoglobin levels in patients undergoing coronary artery bypass grafting? Medicine Science. 2019;8:16-20.
4. 4. Velioglu Y, Yuksel A. Predictors of postoperative atrial fibrillation after beating-heart coronary artery bypass surgery: is cardiopulmonary bypass a risk factor? Acta Cardiol Sin. 2019;35:468-75.
5. 5. Yadava M, Hughey AB, Crawford TC. Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates. Heart Fail Clin. 2016;12:299-308.
6. 6. Mariscalco G, Engström KG, Ferrarese S, Cozzi G, Bruno VD, Sessa F, et al. Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery. J Thorac Cardiovasc Surg. 2006;131:1364-72.
7. 7. Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA. 2004;291:1720-9.
8. 8. Banach M, Rysz J, Drozdz JA, Okonski P, Misztal M, Barylski M, et al. Risk factors of atrial fibrillation following coronary artery bypass grafting: a preliminary report. Circ J. 2006;70:438-41.

9. 9. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des. 2011;17:47-58.
10. 10. Krashin E, Cohen O, Pereg D, Lishner M, Leader A. Mean platelet volume and risk of thrombotic and bleeding complications in patients with Philadelphia chromosome negative myeloproliferative neoplasms. Blood Coagul Fibrinolysis. 2018;29:288-93.
11. 11. Tang WB, Li MX, Li GQ, Cai JD, Wei S, Wan YB. Changes of Mean Platelet Volume, Fibrinogen Content and Blood Rheology in Peripheral Blood of Youth Patients With Cerebral Infarction. Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2012;20:390-3.
12. 12. Murat SN, Duran M, Kalay N, Gunebakmaz O, Akpek M, Doger C, et al. Relation Between Mean Platelet Volume and Severity of Atherosclerosis in Patients With Acute Coronary Syndromes. Angiology. 2013;64:131-6.
13. 13. Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short- and long-term mortality after non ST-elevation myocardial infarction. Am J Cardiol. 2010;106:470-6.
14. 14. Bas HA, Bagci A, Aksoy F. Usefulness of Mean Platelet Volume and Neutrophil-To-Lymphocyte Ratio for Development of Atrial Fibrillation After Acute Myocardial Infarction. Süleyman Demirel Üniversitesi Sağlık Bilimleri Dergisi. 2019;10:278-83.
15. 15. Abeer AT, Effat AE, Wafaa SM, Emad FK. The Predictive Effect of Mean Platelet Volume (MPV) and Neutrophil-to-Lymphocyte Ratio (NLR) on the Functional Outcome of Acute Ischemic Stroke. Med J Cairo Univ. 2018;86:4107-13.
16. 16. Deif RHEE, El-sheikh RG, El-Sokary HM. Relation between Mean Platelet Volume and Supraventricular Tachyarrhythmias. Nature and Science 2019;17(12).
17. 17. Altun İ, Akın F, Biteker M, Köse N, Güz G, Öz F, et al. Mean Platelet Volume in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. Med Bull Haseki. 2015;53:303-7.
18. 18. Degerli V, Ergin I, Duran FY, Ustuner MA, Duran O. Could Mean Platelet Volume Be a Reliable Indicator for Acute Mesenteric Ischemia Diagnosis? A Case-Control Study. Biomed Res Int. 2016;2016:9810280. doi:10.1155/2016/9810280.
19. 19. Feng C, Mei W, Luo C, Long M, Hu X, Huang Y, et al. Relationship between mean platelet volume and coronary blood flow in patients with atrial fibrillation. Heart Lung Circ. 2013;22:43‐9.
20. 20. Gawlita M, Wasilewski J, Osadnik T, Reguła R, Bujak K, Gonera M. Mean platelet volume and platelet-large cell ratio as prognostic factors for coronary artery disease and myocardial infarction. Folia Cardiologica. 2015;10:418-22.
21. 21. Ghahremanfard F, Asghari N, Ghorbani R, Samaei A, Ghomi H, Tamadon M. The relationship between mean platelet volume and severity of acute ischemic brain stroke. Neurosciences (Riyadh). 2013;18:147-51.
22. 22. Bath P, Algert C, Chapman N, Neal B, PROGRESS Collaborative Group. Association of mean platelet volume with risk of stroke among 3134 individuals with history of cerebrovascular disease. Stroke. 2004;35:622-6.
23. 23. Demir ÜF. Mean Platelet Volume Values and Its Effects on Prognosis in Patients with Acute Ischemic Stroke. Bagcilar Med Bull. 2019;4:99-105.
24. 24. Chung I, Choudhury A, Patel J, Lip GY. Soluble CD40L, platelet surface CD40L and total platelet CD40L in congestive heart failure: relationship to platelet volume, mass and granularity. J Intern Med. 2008;263:313-21.
25. 25. Hasan MA, Milon MK, Kashem MA, Karim MR. Effects of Preoperative Mean Platelet Volume on Early Outcomes of Patients After Conventional Coronary Artery Bypass Graft Surgery. University Heart Journal. 2018;14:24-7.
26. 26. Icli A, Aksoy F, Dogan A, Arslan A, Ersoy I, Yucel H, et al. Mean platelet volume may be elevated in mitral valve prolapse and associated with the severity of prolapse. Clin Appl Thromb Hemost. 2013;19:608-12.
27. 27. Boos CJ, Lip GY. Assessment of mean platelet volume in coronary artery disease - what does it mean? Thromb Res. 2007;120:11-3.
28. 28. Velioglu Y, Yuksel A. Complete blood count parameters in peripheral arterial disease. Aging Male. 2019;22:187-91.
29. 29. Korniluk A, Koper-Lenkiewicz OM, Kamińska J, Kemona H, Dymicka-Piekarska V. Mean Platelet Volume (MPV): New Perspectives for an Old Marker in the Course and Prognosis of Inflammatory Conditions. Mediators Inflamm. 2019;2019:9213074. doi:10.1155/2019/9213074
30. 30. Velioglu Y, Yuksel A. Utility of platelet-to-lymphocyte ratio to support the diagnosis of acute deep vein thrombosis. Turk Gogus Kalp Damar Cerrahisi Derg. 2019;27:493-8.
31. 31. van der Planken MG, Vertessen FJ, Vertommen J, Engelen W, Berneman ZN, De Leeuw I. Platelet prothrombinase activity, a final pathway platelet procoagulant activity, is overexpressed in type 1 diabetes: no relationship with mean platelet volume or background retinopathy. Clin Appl Thromb Hemost. 2000;6:65-8.
32. 32. Weymann A, Ali-Hasan-Al-Saegh S, Popov AF, Sabashnikov A, Mirhosseini SJ, Liu T, et al. Haematological 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.