Left atrial strain predicts postoperative atrial fibrillation in patient undergoing major orthopaedic surgery

Background: Atrial fibrillation (AF) is an arrhythmia that often occurred in patients after orthopaedic surgery; the presence of AF affects prognosis and prolongs hospitalization of these patients. Speckle tracking echocardiography (STE) is a new echocardiographic technique that has recently shown to predict the occurrence of AF. The aim of this study was to investigate left atrial (LA) function by STE in patients undergoing orthopaedic surgery and to correlate results with the incidence of post-operative AF. Methods: One-hundred and fifteen patients (mean age 74±12 years), undergoing elective (n=39; 41.9%) or post-traumatic (n=54; 58.0%) orthopaedic surgery, were prospectively enrolled. Both conventional echocardiographic parameters and STE parameters were measured in all subjects the day before surgery. The occurrence of AF was monitored until discharge. Results: Of 115 patients screened, 93 met eligibility criteria; 49 underwent hip surgery, 28 knee surgery and 16 surgery of the shoulder/elbow. All patients received a standard postoperative care. No major surgical complications were recorded. Postoperative AF occurred in 26 patients (27.9%). Among all clinical and echocardiographic variables analyzed, global PALS demonstrated the highest diagnostic accuracy (AUC of 0.88) and, with a cutoff value less than 15.3%, good sensitivity and specificity of 89% and 90%, respectively, to predict postoperative AF episodes. LA volume indexed and E/e’ ratio had lower diagnostic accuracy (AUC 0.70 and 0.49, respectively). Conclusions: STE analysis of LA myocardial deformation could be considered a promising tool for the evaluation of AF risk prediction in patients undergoing orthopaedic surgery.