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Observational Study
. 2015 Oct;29(5):1131-9.
doi: 10.1053/j.jvca.2015.01.023. Epub 2015 Jan 9.

Low Circulating Levels of Growth Differentiation Factor-15 Before Coronary Artery Bypass Surgery May Predict Postoperative Atrial Fibrillation

Olivier Bouchot  1 , Charles Guenancia  2 , Abdelkader Kahli  3 , Charline Pujos  1 , Ghislain Malapert  1 , Catherine Vergely  3 , Gabriel Laurent  4
Affiliations
Observational Study

Low Circulating Levels of Growth Differentiation Factor-15 Before Coronary Artery Bypass Surgery May Predict Postoperative Atrial Fibrillation

Olivier Bouchot et al. J Cardiothorac Vasc Anesth. 2015 Oct.

Abstract

Objectives: To assess the role of growth differentiation factor-15 (GDF-15) as a potential new predictor of postoperative atrial fibrillation (POAF) after off-pump (OFP) and on-pump (ONP) coronary artery bypass graft (CABG) surgery.

Design: Prospective, single-center, observational study.

Setting: University teaching hospital.

Participants: The first 50 patients planned for OFP surgery and the first 50 patients planned for ONP surgery among patients referred for CABG with the following exclusion criteria: age<18 or>80 years, previous atrial fibrillation/flutter, previous treatment with amiodarone, previous cardiac surgery, and emergency surgery.

Interventions: Included patients were equipped with long-duration (7 days) Holter-ECG monitoring.

Measurements and main results: POAF was defined as an AF episode lasting>30 seconds. All patients underwent preoperative echocardiography to assess left ventricular ejection fraction and left atrial diameter. GDF-15 levels were assessed after induction of anesthesia and 12 hours after arrival at the intensive care unit. Among the 100 patients, 34 (34%) developed POAF. In Cox multivariate regression analysis, the EuroSCORE, left atrial diameter>45 mm, and low GDF-15 levels at induction were associated independently with the onset of POAF. In contrast, preoperative NT-proBNP levels did not predict POAF. The use of ONP surgery was not associated with a higher incidence of POAF, even though baseline and follow-up characteristics in ONP and OFP patients were identical.

Conclusions: In patients with no history of AF, a low plasma level of GDF-15 before CABG surgery was a strong independent predictor of POAF. Moreover, preoperative plasma GDF-15 levels added an incremental predictive value to classic risk factors of POAF.

Keywords: atrial fibrillation; biochemistry; cardiopulmonary bypass; coronary artery bypass grafts; off-pump surgery.

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