Perioperative Heart-Type Fatty Acid Binding Protein Levels in Atrial Fibrillation After Cardiac Surgery

Study Questions:

What is the relationship between perioperative levels of heart-type fatty acid binding protein (HT-FABP) and atrial fibrillation (AF)?

Methods:

Blood samples from 63 in-patients undergoing coronary artery bypass grafting (CABG), valve surgery, or both were obtained before and up to 4 days after surgery. Continuous telemetry monitoring was used to detect postoperative AF (POAF). The relationship of HT-FABP with POAF was assessed using joint logistic regression adjusted for age and surgery type.

Results:

Thirty-five patients developed POAF. The age- and CABG-adjusted model revealed that postoperative but not preoperative HT-FABP levels predicted POAF (coefficient 1.9 ± 0.87; p = 0.03). Longer bypass time, prior myocardial infarction, and worse renal function were all associated with higher postoperative HT-FABP.

Conclusions:

The authors concluded that a greater rise of HT-FABP is associated with AF after cardiac surgery, suggesting that ischemic myocardial damage is a contributing underlying mechanism.

Perspective:

AF is extremely common in the perioperative period of patients undergoing CABG or valve surgery, and is associated with worse outcomes. This study demonstrates that elevations of an early and sensitive marker of myocardial ischemia, HT-FABP, are associated with this perioperative complication. This biomarker could possibly be used to guide therapeutic interventions (i.e., anti-ischemic) to prevent AF. This approach will need to be tested in future prospective studies.

Clinical Topics: Arrhythmias and Clinical EP, Dyslipidemia, Atrial Fibrillation/Supraventricular Arrhythmias, Lipid Metabolism

Keywords: Fatty Acid-Binding Proteins, Biological Markers, Perioperative Period, Atrial Fibrillation


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