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. 2009 Jul 30;32(9):E56–E60. doi: 10.1002/clc.20420

Relationship Between Integrated Backscatter and Atrial Fibrosis in Patients with and Without Atrial Fibrillation Who Are Undergoing Coronary Bypass Surgery

Guo‐Dong Wang 1,✉, Lu‐Hua Shen 1, Lei Wang 1, Hong‐Wei Li 1, Yu‐Chen Zhang 1, Hui Chen 1
PMCID: PMC6653025  PMID: 19645046

Abstract

Objective

The purpose of this study was to investigate the relationship between the integrated backscatter (IBS) and atrial fibrosis, with and without atrial fibrillation (AF), in patients who are undergoing coronary bypass grafting (CABG).

Methods

A total of 74 patients (18 preoperative AF, 56 sinus rhythm [SR]) with coronary artery disease undergoing CABG were included. The IBS of the left atrium (LA) posterior wall was acquired from transthoracic echocardiographic examination before surgery. Samples from the LA appendage were collected after opening the pericardium and quantitative assessment of atrial fibrosis was performed with collagen volume fraction (CVF). Postoperative AF was monitored with electrocardiographic telemetry in‐hospital.

Results

There was a positive relationship between age, IBS of the left atrial posterior wall indexed by pericardium (IBS%), and CVF by multivariate linear regression analysis (r = 0.612, p = 0.034; r = 0.887, p < 0.001 respectively). The value of IBS%, LA dimension (LAD), and CVF values were higher in patients with preoperative AF than in patients with preoperative SR (p < 0.001, p < 0.01, p < 0.001, respectively). The value of age, IBS%, and CVF in patients with postoperative AF were higher than in patients without postoperative AF (p = 0.029, p < 0.001, p = 0.001 respectively).

Conclusions

IBS of the LA posterior wall indexed by pericardium provides an objective quantitative measure of atrial fibrosis and correlates with postoperative AF in patients undergoing CABG surgery. Copyright © 2009 Wiley Periodicals, Inc.

Full Text

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References

  • 1. Lee KW, Everett TH, Rahmutula D, et al. Pirfenidone prevents the development of a vulnerable substrate for atrial fibrillation in a canine model of heart failure. Circulation 2006; 114(16): 1703–1712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2. Verheule S, Sato T, Everett TT, et al. Increased vulnerability to atrial fibrillation in transgenic mice with selective atrial fibrosis caused by overexpression of TGF‐beta1. Circ Res 2004; 94(11): 1458–1465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. Boldt A, Wetzel U, Lauschke J, et al. Fibrosis in left atrial tissue of patients with atrial fibrillation with and without underlying mitral valve disease. Heart 2004; 90(4): 400–405. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4. Nakai T, Chandy J, Nakai K, et al. Histologic assessment of right atrial appendage myocardium in patients with atrial fibrillation after coronary artery bypass graft surgery. Cardiology 2006; 108(2): 90–96. [DOI] [PubMed] [Google Scholar]
  • 5. Mathew JP, Fontes ML, Tudor IC, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004; 291: 1720–1729. [DOI] [PubMed] [Google Scholar]
  • 6. Hogue CW, Creswell LL, Gutterman DD, Fleisher LA. Epidemiology, mechanisms, and risks: American College of Chest Physicians guidelines for the prevention and management of postoperative atrial fibrillation after cardiac surgery. Chest 2005; 128(suppl): 9s–16s. [DOI] [PubMed] [Google Scholar]
  • 7. Lythall DA, Bishop J, Greembaum RA, et al. Relationship between myocardial collagen and echo amplitude in non‐fibrotic heart. Eur Heart J 1993; 14: 344–350. [DOI] [PubMed] [Google Scholar]
  • 8. Hall CS, Scott MJ, Lanza GM. The extracellular matrix is an important source of ultrasound backscatter from myocardium. J Acoust Soc Am 2000; 107: 612–619. [DOI] [PubMed] [Google Scholar]
  • 9. Picano E, Pelosi G, Marzilli M, et al. In vivo quantitatively ultrasonic evaluation of myocardial fibrosis in humans. Circulation 1990; 81: 58–64. [DOI] [PubMed] [Google Scholar]
  • 10. Nakai T, Chandy J, Nakai K, et al. Histologic assessment of right atrial appendage myocardium in patients with atrial fibrillation after coronary artery bypass graft surgery. Cardiology 2007; 108(2): 90–96. [DOI] [PubMed] [Google Scholar]
  • 11. Goldman JH, Ehlgen A, Ursell PC, Schiller NB. Left atrial size is a poor predictor of pathology in the older patient: Preliminary observations. Echocardiography 2006; 23(1): 24–30. [DOI] [PubMed] [Google Scholar]
  • 12. Di Bello V, Santini F, Di Cori A, et al. Obesity cardiomyopathy: Is it a reality? An ultrasonic tissue characterization study. J Am Soc Echocardiogr 2006; 19(8): 1063–1071. [DOI] [PubMed] [Google Scholar]
  • 13. Pacileo G, Limongelli G, Verrengia M, et al. Backscatter evaluation of myocardial functional and textural findings in children with right ventricular pressure and/or volume overload. Am J Cardiol 2004; 93(5): 594–597. [DOI] [PubMed] [Google Scholar]
  • 14. Tekten T, Onbaşili OA, Ceyhan C, Ercan E. The relationship of the left atrial spontaneous echo contrast integrated backscatter with left atrial appendix function and tissue doppler characteristics. Anadolu Kardiyol Derg 2002; 2(2): 113–118; AXVI. [PubMed] [Google Scholar]
  • 15. Chen MF, Lee YT, Huang PJ. Integrated backscatter for quantification and risk stratification of blood stagnation in left atrial appendages of patients with rheumatic mitral stenosis. Cardiology 2000; 93(1–2): 113–120. [DOI] [PubMed] [Google Scholar]
  • 16. Frustaci A, Chimenti C, Bellocci F, et al. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation 1997; 96: 1180–1184. [DOI] [PubMed] [Google Scholar]
  • 17. Spach MS, Boineau JP. Microfibrosis produces electrical load variations due to loss of side‐to‐side cell connections: A major mechanism of structural heart disease arrhythmias. Pacing Clin Electrophysiol 1997; 20(2 Pt 2): 397–413. [DOI] [PubMed] [Google Scholar]
  • 18. Kostin S, Klein G, Szalay Z, et al. Structural correlate of atrial fibrillation in human patients. Cardiovasc Res 2002; 54(2): 361–379. [DOI] [PubMed] [Google Scholar]
  • 19. Anyukhoversusky EP, Sosunov EA, Plotnikov A, et al. Cellular electrophysiologic properties of old canine atria provide a substrate for arrhythmogenesis. Cardiovasc Res 2002; 54(2): 462–469. [DOI] [PubMed] [Google Scholar]
  • 20. Lee KW, Everett THT, Rahmutula D, et al. Pirfenidone prevents the development of a vulnerable substrate for atrial fibrillation in a canine model of heart failure. Circulation 2006; 114(16): 1703–1712. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Mathew JP, Parks R, Savino JS, et al. Atrial fibrillation following coronary artery bypass graft surgery: Predictors, outcomes, and resource utilization. Multicenter Study of Perioperative Ischemia Research Group. JAMA 1996; 276: 300–306. [PubMed] [Google Scholar]
  • 22. Goette A, Juenemann G, Peters B, et al. Determinants and consequences of atrial fibrosis in patients undergoing open heart surgery. Cardiovasc Res 2002; 54: 390–396. [DOI] [PubMed] [Google Scholar]
  • 23. Dupont E, Ko Y, Rothery S, et al. The gapjunctional protein connexin40 is elevated in patients susceptible to postoperative atrial fibrillation. Circulation 2001; 103: 842–849. [DOI] [PubMed] [Google Scholar]
  • 24. Mariscalco G, Engstrom KG, Ferrarese S, et al. Relationship between atrial histopathology and atrial fibrillation after coronary bypass surgery. J Thorac Cardiovasc Surg 2006; 131(6): 1364–1372. [DOI] [PubMed] [Google Scholar]

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