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RESEARCH PRODUCT

0058 : Low circulating levels of Growth Differentiation Factor 15 (GDF-15) before coronary artery bypass surgery may predict post-operative atrial fibrillation

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BackgroundPost-operative atrial fibrillation (POAF) following cardiac surgery has a high prevalence and is associated with considerable morbidity.AimsTo assess the role of GDF-15, a member of the TGFβsuperfamily, as a potential new predictor of POAF after off-pump (OFP) and on-pump (ONP) coronary artery bypass graft (CABG) surgery.MethodsThis observational study recruited the first 50 patients planned for OFP surgery and the first 50 patients planned for ONP surgery. Patients referred for CABG with the following exclusion criteria: age 80 years, previous atrial fibrillation/flutter, previous treatment with Amiodarone, previous cardiac surgery, emergency surgery. Included patients were equipped with long-duration (7 days) Holter ECG monitoring. POAF was defined as an AF episode lasting >30 seconds. All patients underwent pre-operative echocardiography to assess LVEF and left atrial diameter. GDF-15 levels were assessed at induction of anaesthesia and 12 hours after the end of surgery.ResultsAmong the 100 patients, 34 developed POAF. In Cox multivariate regression analysis, the EuroSCORE, left atrial diameter>45mm and low GDF- 15 levels at induction (<1200 ng/l) were independently associated with the onset of POAF. When comparing the incremental prognostic value of GDF-15 according to the time of blood sampling, we found that a low circulating level of GDF-15 at induction was a better predictor of POAF than that 12h later. In contrast, pre-operative 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.ConclusionIn patients with no history of AF, a low plasma level of GDF- 15 before CABG surgery was a strong and independent predictor of POAF. Moreover, preoperative plasma GDF-15 levels added an incremental predictive value to classical risk factors of POAF.