The relationship between inflammatory biomarkers and postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENG Yukun , LIU Yiyang ,  LIU Yisi

Capital Medical University, Beijing, 100069, P.R.China;

Corresponding?author：

LIU Yisi, Email: asceticsisi@aliyun.com

Keywords：

Atrial fibrillation; coronary artery bypass grafting; valve replacement; inflammation; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202007050

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Objective To evaluate the relationship between four classic inflammatory biomarkers, including C-reactive protein (CRP), white blood cell (WBC), IL (interleukin family), tumor necrosis factor-α (TNF-α), and postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) and valve replacement (VR) surgeries.Methods We searched PubMed, EMBase, the Cochrane Library, Ovid, Chinese Journal Full-text Database, Chinese Biomedical Literature Database, VIP database and WanFang database from the inception to April 2020. Studies on the relationship between POAF and the above four inflammatory biomarkers were analyzed. Two researchers independently reviewed the literature, extracted data and evaluated the quality of the literature. RevMan 5.3 software was used for meta-analysis.Results A total of 47 articles were included, covering 10 711 patients. The levels of preoperative CRP (SMD=0.38, 95%CI 0.14-0.62, Z=3.12, P=0.002) and postoperative CRP (SMD=0.40, 95%CI 0.06-0.74, Z=2.33, P=0.02), IL-6 (SMD=1.34, 95%CI 0.98-1.70, Z=7.26, P<0.001) and TNF-α (SMD=?0.33, 95%CI ?0.65-?0.01, Z=2.02, P=0.040) were related to POAF, while preoperative IL-8 (SMD=?0.05, 95%CI ?0.28-0.18, Z=0.42, P=0.68) and TNF-α (SMD=?0.43, 95%CI ?1.22-0.36, Z=1.07, P=0.28), postoperative WBC (WMD=1.16, 95%CI ?0.09-2.42, Z=1.82, P=0.07) and IL-10 (SMD=0.21, 95%CI ?0.35-0.77, Z=0.73, P=0.46) were not related to POAF. The relationships between preoperative WBC and IL-10, postoperative IL-8 and POAF were inclusive, which needed further verification. Furthermore, the relationship between postoperative CRP and POAF were not consistent, as they were not significantly correlated in sub-group analysis.Conclusion The inflammatory substrate before the surgery and inflammatory reaction induced by the operation is related to the occurrence and maintenance of POAF. Compared with preoperative inflammatory status, postoperative inflammatory factors may have a greater predictive value for POAF. Preoperative CRP, postoperative IL-6 and TNF-α levels are reliable biomarkers of POAF.

Citation： ZHENG Yukun, LIU Yiyang, LIU Yisi. The relationship between inflammatory biomarkers and postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(5): 578-591. doi: 10.7507/1007-4848.202007050 Copy

1.	Filardo G, Damiano RJ, Ailawadi G, et al. Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery. Heart, 2018, 104(12): 985-992.
2.	Filardo G, Ailawadi G, Pollock BD, et al. Sex differences in the epidemiology of new-onset in-hospital post-coronary artery bypass graft surgery atrial fibrillation: A large multicenter study. Circ Cardiovasc Qual Outcomes, 2016, 9(6): 723-730.
3.	王玨. 胺碘酮對預防心臟不停跳冠狀動脈搭橋術后房顫發生的影響. 中國處方藥, 2019, 17(6): 101-102.
4.	Greenberg JW, Lancaster TS, Schuessler RB, et al. Postoperative atrial fibrillation following cardiac surgery: A persistent complication. Eur J Cardiothorac Surg, 2017, 52(4): 665-672.
5.	Kosmidou I, Stone GW. New-onset atrial fibrillation after PCI and CABG for left main disease: Insights from the EXCEL trial and additional studies. Curr Opin Cardiol, 2018, 33(6): 660-664.
6.	Jacob KA, Nathoe HM, Dieleman JM, et al. Inflammation in new-onset atrial fibrillation after cardiac surgery: A systematic review. Eur J Clin Invest, 2014, 44(4): 402-428.
7.	Weymann A, Popov AF, Sabashnikov A, et al. Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: A systematic review and meta-analysis. Kardiol Pol, 2018, 76(2): 440-451.
8.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
9.	Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
10.	曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
11.	李河, 麥勁壯, 方積乾, 等. Meta 分析中漏斗圖的繪制. 循證醫學, 2007, 7(2): 101-104, 106.
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13.	Saskin H, Serhan Ozcan K, Yilmaz S. High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Interact Cardiovasc Thorac Surg, 2017, 24(3): 395-401.
14.	?a?k?n H, Düzyol ?, Aksoy R, et al. Do preoperative C-reactive protein and mean platelet volume levels predict development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting? Postepy Kardiol Interwencyjnej, 2016, 12(2): 156-163.
15.	Cerit L, Duygu H, Gulsen K, et al. Is SYNTAX score predictive of atrial fibrillation after on-pump coronary artery bypass graft surgery? Korean Circ J, 2016, 46(6): 798-803.
16.	Anato?evna RO, Veniaminovich FO, Mikhaylovich KS. Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft. J Geriatr Cardiol, 2016, 13(5): 444-449.
17.	Korantzopoulos P, Sontis N, Liu T, et al. Association between red blood cell distribution width and postoperative atrial fibrillation after cardiac surgery: A pilot observational study. Int J Cardiol, 2015, 185: 19-21.
18.	Erdem K, Oztürk S, Ayhan S, et al. Predictive value of aortic knob width for postoperative atrial fibrillation in coronary artery bypass surgery. Anadolu Kardiyol Derg, 2014, 14(1): 68-72.
19.	Narducci ML, Pelargonio G, Rio T, et al. Predictors of postoperative atrial fibrillation in patients with coronary artery disease undergoing cardiopulmonary bypass: A possible role for myocardial ischemia and atrial inflammation. J Cardiothorac Vasc Anesth, 2014, 28(3): 512-519.
20.	Erdem K, Ayhan S, Ozturk S, et al. Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting. Platelets, 2014, 25(1): 23-26.
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24.	Ishida K, Kimura F, Imamaki M, et al. Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg, 2006, 29(4): 501-505.
25.	Cosgrave J, Foley JB, Kelly R, et al. Perioperative serum inflammatory response and the development of atrial fibrillation after coronary artery bypass surgery. Heart, 2005, 91(11): 1475-1476.
26.	Mandal K, Jahangiri M, Mukhin M, et al. Association of anti-heat shock protein 65 antibodies with development of postoperative atrial fibrillation. Circulation, 2004, 110(17): 2588-2590.
27.	Oc M, Ucar HI, Pinar A, et al. Heat shock protein70: A new marker for subsequent atrial fibrillation development? Artif Organs, 2008, 32(11): 846-850.
28.	Carter-Storch R, Dahl JS, Christensen NL, et al. Postoperative atrial fibrillation after aortic valve replacement is a risk factor for long-term atrial fibrillation. Interact Cardiovasc Thorac Surg, 2019, 29(3): 378-385.
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30.	Jacob KA, Buijsrogge MP, Frencken JF, et al. White blood cell count and new-onset atrial fibrillation after cardiac surgery. Int J Cardiol, 2017, 228: 971-976.
31.	Kinoshita T, Asai T, Takashima N, et al. Preoperative C-reactive protein and atrial fibrillation after off-pump coronary bypass surgery. Eur J Cardiothorac Surg, 2011, 40(6): 1298-1303.
32.	Lamm G, Auer J, Weber T, et al. Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth, 2006, 20(1): 51-56.
33.	Abdelhadi RH, Gurm HS, Van Wagoner DR, et al. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation postoperatively. Am J Cardiol, 2004, 93(9): 1176-1178.
34.	Gasparovic H, Burcar I, Kopjar T, et al. NT-pro-BNP, but not C-reactive protein, is predictive of atrial fibrillation in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg, 2010, 37(1): 100-105.
35.	Choi YS, Shim JK, Hong SW, et al. Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: Predictive value of C-reactive protein and transfusion requirement. Eur J Cardiothorac Surg, 2009, 36(5): 838-843.
36.	Fontes ML, Amar D, Kulak A, et al. Increased preoperative white blood cell count predicts postoperative atrial fibrillation after coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 2009, 23(4): 484-487.
37.	Sezai A, Hata M, Niino T, et al. Study of the factors related to atrial fibrillation after coronary artery bypass grafting: A search for a marker to predict the occurrence of atrial fibrillation before surgical intervention. J Thorac Cardiovasc Surg, 2009, 137(4): 895-900.
38.	Ucar HI, Tok M, Atalar E, et al. Predictive significance of plasma levels of interleukin-6 and high-sensitivity C-reactive protein in atrial fibrillation after coronary artery bypass surgery. Heart Surg Forum, 2007, 10(2): E131-E135.
39.	Ahlsson AJ, Bodin L, Lundblad OH, et al. Postoperative atrial fibrillation is not correlated to C-reactive protein. Ann Thorac Surg, 2007, 83(4): 1332-1337.
40.	Hogue CW, Palin CA, Kailasam R, et al. C-reactive protein levels and atrial fibrillation after cardiac surgery in women. Ann Thorac Surg, 2006, 82(1): 97-102.
41.	Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol, 2010, 105(2): 186-191.
42.	Girerd N, Pibarot P, Fournier D, et al. Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery. Eur Heart J, 2009, 30(10): 1270-1278.
43.	Limite LR, Magnoni M, Berteotti M, et al. The predictive role of renal function and systemic inflammation on the onset of de novo atrial fibrillation after cardiac surgery. Eur J Prev Cardiol, 2016, 23(2): 206-213.
44.	Antoniades C, Van-Assche T, Shirodaria C, et al. Preoperative sCD40L levels predict risk of atrial fibrillation after off-pump coronary artery bypass graft surgery. Circulation, 2009, 120(11 Suppl): S170-S176.
45.	Fontes ML, Mathew JP, Rinder HM, et al. Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation. Anesth Analg, 2005, 101(1): 17-23.
46.	Durukan AB, Gurbuz HA, Unal EU, et al. Role of neutrophil/lymphocyte ratio in assessing the risk of postoperative atrial fibrillation. J Cardiovasc Surg (Torino), 2014, 55(2): 287-293.
47.	Hak ?, My?liwska J, Wieckiewicz J, et al. Interleukin-2 as a predictor of early postoperative atrial fibrillation after cardiopulmonary bypass graft (CABG). J Interferon Cytokine Res, 2009, 29(6): 327-332.
48.	Mirhosseini SJ, Ali-Hassan-Sayegh S, Forouzannia SK. What is the exact predictive role of preoperative white blood cell count for new-onset atrial fibrillation following open heart surgery? Saudi J Anaesth, 2013, 7(1): 40-42.
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1. Filardo G, Damiano RJ, Ailawadi G, et al. Epidemiology of new-onset atrial fibrillation following coronary artery bypass graft surgery. Heart, 2018, 104(12): 985-992.
2. Filardo G, Ailawadi G, Pollock BD, et al. Sex differences in the epidemiology of new-onset in-hospital post-coronary artery bypass graft surgery atrial fibrillation: A large multicenter study. Circ Cardiovasc Qual Outcomes, 2016, 9(6): 723-730.
3. 王玨. 胺碘酮對預防心臟不停跳冠狀動脈搭橋術后房顫發生的影響. 中國處方藥, 2019, 17(6): 101-102.
4. Greenberg JW, Lancaster TS, Schuessler RB, et al. Postoperative atrial fibrillation following cardiac surgery: A persistent complication. Eur J Cardiothorac Surg, 2017, 52(4): 665-672.
5. Kosmidou I, Stone GW. New-onset atrial fibrillation after PCI and CABG for left main disease: Insights from the EXCEL trial and additional studies. Curr Opin Cardiol, 2018, 33(6): 660-664.
6. Jacob KA, Nathoe HM, Dieleman JM, et al. Inflammation in new-onset atrial fibrillation after cardiac surgery: A systematic review. Eur J Clin Invest, 2014, 44(4): 402-428.
7. Weymann A, Popov AF, Sabashnikov A, et al. Baseline and postoperative levels of C-reactive protein and interleukins as inflammatory predictors of atrial fibrillation following cardiac surgery: A systematic review and meta-analysis. Kardiol Pol, 2018, 76(2): 440-451.
8. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
9. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA, 2000, 283(15): 2008-2012.
10. 曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
11. 李河, 麥勁壯, 方積乾, 等. Meta 分析中漏斗圖的繪制. 循證醫學, 2007, 7(2): 101-104, 106.
12. Xu S, Zhang J, Xu YL, et al. Relationship between angiotensin converting enzyme, apelin, and new-onset atrial fibrillation after off-pump coronary artery bypass grafting. Biomed Res Int, 2017: 7951793.
13. Saskin H, Serhan Ozcan K, Yilmaz S. High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Interact Cardiovasc Thorac Surg, 2017, 24(3): 395-401.
14. ?a?k?n H, Düzyol ?, Aksoy R, et al. Do preoperative C-reactive protein and mean platelet volume levels predict development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting? Postepy Kardiol Interwencyjnej, 2016, 12(2): 156-163.
15. Cerit L, Duygu H, Gulsen K, et al. Is SYNTAX score predictive of atrial fibrillation after on-pump coronary artery bypass graft surgery? Korean Circ J, 2016, 46(6): 798-803.
16. Anato?evna RO, Veniaminovich FO, Mikhaylovich KS. Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft. J Geriatr Cardiol, 2016, 13(5): 444-449.
17. Korantzopoulos P, Sontis N, Liu T, et al. Association between red blood cell distribution width and postoperative atrial fibrillation after cardiac surgery: A pilot observational study. Int J Cardiol, 2015, 185: 19-21.
18. Erdem K, Oztürk S, Ayhan S, et al. Predictive value of aortic knob width for postoperative atrial fibrillation in coronary artery bypass surgery. Anadolu Kardiyol Derg, 2014, 14(1): 68-72.
19. Narducci ML, Pelargonio G, Rio T, et al. Predictors of postoperative atrial fibrillation in patients with coronary artery disease undergoing cardiopulmonary bypass: A possible role for myocardial ischemia and atrial inflammation. J Cardiothorac Vasc Anesth, 2014, 28(3): 512-519.
20. Erdem K, Ayhan S, Ozturk S, et al. Usefulness of the mean platelet volume for predicting new-onset atrial fibrillation after isolated coronary artery bypass grafting. Platelets, 2014, 25(1): 23-26.
21. Pilatis ND, Anyfantakis ZA, Spiliopoulos K, et al. The role of BNP and CRP in predicting the development of atrial fibrillation in patients undergoing isolated coronary artery bypass surgery. ISRN Cardiol, 2013, 2013: 235018.
22. Cao H, Zhou Q, Wu Y, et al. Preoperative serum soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin predict postoperative atrial fibrillation in patients undergoing cardiac valve surgery. Ann Thorac Surg, 2013, 96(3): 800-806.
23. Bjorgvinsdottir L, Arnar DO, Indridason OS, et al. Do high levels of N-3 polyunsaturated fatty acids in cell membranes increase the risk of postoperative atrial fibrillation? Cardiology, 2013, 126(2): 107-114.
24. Ishida K, Kimura F, Imamaki M, et al. Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg, 2006, 29(4): 501-505.
25. Cosgrave J, Foley JB, Kelly R, et al. Perioperative serum inflammatory response and the development of atrial fibrillation after coronary artery bypass surgery. Heart, 2005, 91(11): 1475-1476.
26. Mandal K, Jahangiri M, Mukhin M, et al. Association of anti-heat shock protein 65 antibodies with development of postoperative atrial fibrillation. Circulation, 2004, 110(17): 2588-2590.
27. Oc M, Ucar HI, Pinar A, et al. Heat shock protein70: A new marker for subsequent atrial fibrillation development? Artif Organs, 2008, 32(11): 846-850.
28. Carter-Storch R, Dahl JS, Christensen NL, et al. Postoperative atrial fibrillation after aortic valve replacement is a risk factor for long-term atrial fibrillation. Interact Cardiovasc Thorac Surg, 2019, 29(3): 378-385.
29. He Y, Chen X, Guo X, et al. Th17/Treg ratio in serum predicts onset of postoperative atrial fibrillation after off-pump coronary artery bypass graft surgery. Heart Lung Circ, 2018, 27(12): 1467-1475.
30. Jacob KA, Buijsrogge MP, Frencken JF, et al. White blood cell count and new-onset atrial fibrillation after cardiac surgery. Int J Cardiol, 2017, 228: 971-976.
31. Kinoshita T, Asai T, Takashima N, et al. Preoperative C-reactive protein and atrial fibrillation after off-pump coronary bypass surgery. Eur J Cardiothorac Surg, 2011, 40(6): 1298-1303.
32. Lamm G, Auer J, Weber T, et al. Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth, 2006, 20(1): 51-56.
33. Abdelhadi RH, Gurm HS, Van Wagoner DR, et al. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation postoperatively. Am J Cardiol, 2004, 93(9): 1176-1178.
34. Gasparovic H, Burcar I, Kopjar T, et al. NT-pro-BNP, but not C-reactive protein, is predictive of atrial fibrillation in patients undergoing coronary artery bypass surgery. Eur J Cardiothorac Surg, 2010, 37(1): 100-105.
35. Choi YS, Shim JK, Hong SW, et al. Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: Predictive value of C-reactive protein and transfusion requirement. Eur J Cardiothorac Surg, 2009, 36(5): 838-843.
36. Fontes ML, Amar D, Kulak A, et al. Increased preoperative white blood cell count predicts postoperative atrial fibrillation after coronary artery bypass surgery. J Cardiothorac Vasc Anesth, 2009, 23(4): 484-487.
37. Sezai A, Hata M, Niino T, et al. Study of the factors related to atrial fibrillation after coronary artery bypass grafting: A search for a marker to predict the occurrence of atrial fibrillation before surgical intervention. J Thorac Cardiovasc Surg, 2009, 137(4): 895-900.
38. Ucar HI, Tok M, Atalar E, et al. Predictive significance of plasma levels of interleukin-6 and high-sensitivity C-reactive protein in atrial fibrillation after coronary artery bypass surgery. Heart Surg Forum, 2007, 10(2): E131-E135.
39. Ahlsson AJ, Bodin L, Lundblad OH, et al. Postoperative atrial fibrillation is not correlated to C-reactive protein. Ann Thorac Surg, 2007, 83(4): 1332-1337.
40. Hogue CW, Palin CA, Kailasam R, et al. C-reactive protein levels and atrial fibrillation after cardiac surgery in women. Ann Thorac Surg, 2006, 82(1): 97-102.
41. Gibson PH, Cuthbertson BH, Croal BL, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol, 2010, 105(2): 186-191.
42. Girerd N, Pibarot P, Fournier D, et al. Middle-aged men with increased waist circumference and elevated C-reactive protein level are at higher risk for postoperative atrial fibrillation following coronary artery bypass grafting surgery. Eur Heart J, 2009, 30(10): 1270-1278.
43. Limite LR, Magnoni M, Berteotti M, et al. The predictive role of renal function and systemic inflammation on the onset of de novo atrial fibrillation after cardiac surgery. Eur J Prev Cardiol, 2016, 23(2): 206-213.
44. Antoniades C, Van-Assche T, Shirodaria C, et al. Preoperative sCD40L levels predict risk of atrial fibrillation after off-pump coronary artery bypass graft surgery. Circulation, 2009, 120(11 Suppl): S170-S176.
45. Fontes ML, Mathew JP, Rinder HM, et al. Atrial fibrillation after cardiac surgery/cardiopulmonary bypass is associated with monocyte activation. Anesth Analg, 2005, 101(1): 17-23.
46. Durukan AB, Gurbuz HA, Unal EU, et al. Role of neutrophil/lymphocyte ratio in assessing the risk of postoperative atrial fibrillation. J Cardiovasc Surg (Torino), 2014, 55(2): 287-293.
47. Hak ?, My?liwska J, Wieckiewicz J, et al. Interleukin-2 as a predictor of early postoperative atrial fibrillation after cardiopulmonary bypass graft (CABG). J Interferon Cytokine Res, 2009, 29(6): 327-332.
48. Mirhosseini SJ, Ali-Hassan-Sayegh S, Forouzannia SK. What is the exact predictive role of preoperative white blood cell count for new-onset atrial fibrillation following open heart surgery? Saudi J Anaesth, 2013, 7(1): 40-42.
49. Garcia L, Verdejo HE, Kuzmicic J, et al. Impaired cardiac autophagy in patients developing postoperative atrial fibrillation. J Thorac Cardiovasc Surg, 2012, 143(2): 451-459.
50. Gabrielli L, Corbalan R, Córdova S, et al. Left atrial dysfunction is a predictor of postcoronary artery bypass atrial fibrillation: association of left atrial strain and strain rate assessed by speckle tracking. Echocardiography, 2011, 28(10): 1104-1108.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The relationship between inflammatory biomarkers and postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis

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