LAUSR

BACKGROUND Post-operative atrial fibrillation (POAF) represents a common complication after cardiac surgery associated with major adverse events and poor patient-outcome. Tools for risk stratification of this arrhythmia remain scarce. Atrial-natriuretic peptide (ANP) represents an easily assessable biomarker picturing atrial function and strain - however, its prognostic potential on the development of POAF has not been investigated so far. METHODS Within the present investigation, 314 patients undergoing elective cardiac surgery were prospectively enrolled. Preoperative MR-proANP values were assessed before the surgical intervention. Patients were followed prospectively and continuously screened for the development of arrhythmic events. RESULTS A total of 138 individuals (43.9%) developed POAF. Median concentration of MR-proANP were significantly higher within the POAF group (p<0.001). MR-proANP showed a strong association with the development of POAF with a crude odds ratio (OR) of 1.68 per one standard deviation (1-SD; 95%CI 1.31-2.15; p<0.001) which remained stable after comprehensive adjustment for confounders with an adjusted OR of 1.74 per 1-SD (95%CI 1.17-2.58; p=0.006). The discriminatory power of MR-proANP for the development of POAF was validated by the category-free net reclassification improvement (NRI; 0.23 [95%CI: 0.0349 - 0.4193]; p = 0.022) and integrated discrimination increment (IDI; 0.02 [95%CI 0.0046 - 0.0397], p = 0.013). CONCLUSION MR-proANP proved to be a strong and independent predictor of the development of POAF. Considering a personalized diagnostic and prognostic pre-operative work up, a standardized pre-operative evaluation of MR-proANP levels might help to identify patients at risk for development of POAF after cardiac surgery.