The Relationship Between NT-proBNP And New Onset Atrial Fibrillation After Mitral Valve Replacement Surgery

BackgroundAtrial fibrillation (AF) is the most common clinical chronic and recurrent episodes of tachyarrhythmia,with high morbidity and mortality. At the same time,it is one of the most common complications after cardiac surgery in the clinial statistics. The incidence reported in foreign countries is 10-60%,where the incidence of atrial fibrillation after coronary artery bypass is about thirty percent and it occured in vavular surgery is approximately forty percent,but after coronary artery bypass surgery combined with vavular surgery it rises to over fifty percent.However, postoperative atrial fibrillation will lead to the average hospitalization longer days, hemodynamic instability, the risk of stroke and the increasing of death rate, thus affecting the early and long-term effect of the operation, and even increasing the economic burden of the patients.At the same time, the Yunnan-Guizhou plateau, located in the southwest region of our country, the most part of its area is the mountain and ethnic minority lives in it, its rural population accounts for a large proportion, but its social and economic development is relatively backward. In that coronary heart disease (CHD) gradually occupies the subject today, valvular heart disease in Yunnan Guizhou Plateau. still occupy a large proportion, so clearing what’s the postoperative atrial fibrillation in the etiology, pathogenesis mechanism, reducing even preventing the occurrence of postoperative atrial fibrillation is very necessary.ObjectiveThe purpose of this study was to assess the predictive value of atrial fibrillation in patients with valvular heart disease by testing the serum levels of NT-proBNP in patients with valvular heart disease.MethodsSelectiing 40 patients who has been experienced with valvular surgery in our department from January,2015 to January.2016.All patients were living in the Yunnan-Guizhou Platrau and had a normal ejection fraction.All of them were excluded from chronic atrial fibrillation, ECG ST segment and T wave abnormalities, renal insufficiency, white blood cell reduction, taking steroid hormone,preoperative application of anti arrhythmia drugs,preoperative echocardiography exclusion of atrial thrombus.Finally selected 40 cases,including 18 cases of male and 22 cases of female,aged 23-72 years old,average age(46.7±12.7)years old.During the whole preopeative living days,laboratory testing of serum NT-proBNP,standard twelve lead elctrocardiogram,Holter,chest X-ray,echocardiography and so on would be routine done.The diastolic diameter of the left ventricular(28-51mm,37.2±7.3mm) and left ventricular ejection fraction,LVEF,(50-72%,60.5±5.7%) were measured by echocardioguraphy.Valve surgeries were performed in all patients by the same cardiovascular surgeon, the same extracorporeal circulation perfusion.Under the general anesthesia, the median thoracotomy was performed in the patients undergoing tracheal intubation.Valve operation would be done by right atrial apporach undergoing the cardiopulmonary bypass.All of the heart rhythms were sinus rhythm after operation.Postoperative days routine returned to cardiovascular surgery intensive care unit with continuous ECG monitoring.Respectively,acquisition of venous blood in the early intensive care unit(HO),postoperative 3 hour(H3),and of the early morning fasting venous blood in the first day,second days,third days after the operation would be collected for detection NT-proBNP. If the atrial fibrillation was monitered and lasted for more than 15min, we would stop monitoring.ResultsThere are 18 new cases of atrial fibrillation including 8 males(44.4%) during the whole 40 patients who has experienced with the valvular surgery and the incidence rate is 45%.The time of postoperative atrial fibrillation was (19-168) h after operation. The average time (55.5+32.6) h,2-3 days after the operation, is basically consistent with domestic research.Sex (P=0.827), age (P=0.807), LVEF (P=0.655), LA (P=0.964) all had no effect on postoperative atrial fibrillation. The study showed that the level of NT-proBNP increased rapidly and reached the peak at 2-3 days after operation and then decreased.Detection of serum NT proBNP levels in the first postoperative day HO and H3 were greater than 340.7pg/ml,384.0pg/ml for patients living in the areas of the Yunnan Guizhou Plateau after heart surgery complicated with atrial fibrillation have predictive value.In H0, the sensitivity was 0.889, the specificity was 0.818, and the area under the curve was 0.888 (95%:0.785-0.991) and in H3, the sensitivity was 0.889, the specificity was 0.864, the area under the curve was 0.926 (95%:0.839-1.0).ConclusionThe study used the enzyme linked immunosorbent assay to detect the patients in Yunnan Guizhou Plateau area of valvular heart disease operation occurred postoperative atrial fibrillation with preoperative and postoperative early serum NT proBNP levels and to evaluate the relationship between NT proBNP and postoperative atrial fibrillation (AF).The study showed that serum NT proBNP levels in the first postoperative day HO and H3 were greater than 340.7pg/ml,384.0pg/ml for patients living in the areas of the Yunnan Guizhou Plateau after heart surgery complicated with atrial fibrillation will hasve predictive value.This study guides the monitoring of NT-proBNP levels in the early postoperative period in patients with valvular heart disease.For early intervention on postoperative atrial fibrillation (AF) and postoperative atrial fibrillation level zero or one level prevention, indirectly enhance the effect of surgery and reduce the economic and social burden of vavular patients living in the Yunnan Guizhou Plateau, while avoiding the medical resources excessive use, it is worth for clinical use.