ALDOsterone for Prediction of Post-Operative Atrial Fibrillation

Study Overview
=================
Brief Summary
-----------------
Post-operative atrial fibrillation (POAF) is a major and frequent complication occurring after cardiac surgery, contributing to prolonged intensive care and hospital stays and is associated with several cardiovascular complications. The exact mechanisms and signaling pathways involved in the development of POAF seem to be multifactorial and remain to date incompletely understood. β-blockers and amiodarone are the first line preventive drugs but are partially effective and near 30% of POAF resist to these strategies. In this context, there is some evidence indicating that renin-angiotensin-aldosterone system and Galectin-3 (Gal-3) share signaling pathways in the development of cardiac fibrosis and therefore could be very useful predictive biomarkers of POAF and potentially interesting therapeutic target to prevent POAF occurrence. The investigators hypothesis is that preoperative plasma aldosterone levels and galectin-3 (Gal-3) expression (in plasma, right atrial appendage or epicardial fat) could be predictive of POAF in patients undergoing elective CABG surgery with preserved LVEF.

Official Title
-----------------
ALDOsterone for Prediction of Post-Operative Atrial Fibrillation

Conditions
-----------------
Atrial Fibrillation

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients hospitalized for planned surgical coronary revascularization +/- aortic replacement valve Aged 18 years at least Clinically Stable (see criteria for non-inclusion) With left ventricular ejection fraction preserved (>50%) Exclusion Criteria: Patient having already AF history Patient with primary hyperaldosteronism Unstable Patient defined as any cardiovascular event occurred in the previous 30 days These events are: hospitalisation for cardiovascular causes appearance or worsening of symptoms consistent with cardiac failure appearance or worsening symptoms of coronary Patient refusing participation in the study Patient unable to provide follow-up visits need for concomitant mitral surgery Emergency CABG Left ventricular ejection fraction (LVEF) < 50% Previous heart surgery Off pump CABG.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Planned cardiac surgery. POAF occurence or not<br>The ALDO-POAF study is an observational, 1-center and prospective pilot study that will enroll patients undergoing CABG ± aortic valve replacement. Patients who had emergency CABG, need for concomitant mitral surgery, left ventricular ejection fraction (LVEF) < 50%, a history of AF or other atrial arrhythmia, unstable angina or heart failure, cardiogenic shock, atrioventricular block, hypothyroidism/hyperthyroidism, previous heart surgery, and off-pump or on-pump beating CABG will be excluded. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Occurrence of atrial fibrillation in post-operative period of cardiac surgery (CABG +/- aortic valve replacement) |  | 1 month | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Find a correlation between the local secretion of aldosterone by adipocytes epicardial and the occurrence of AF during the 6 months after surgery in patients undergoing cold bypass coronary artery. |  | 6 months | 
| Find a correlation between aldosterone levels secreted in epicardial adipocytes and plasma aldosterone levels. |  | 1 month | 
| Find a correlation between preoperative plamastic aldosterone levels and occurence of postoperative atrial fibrillation |  | 1 month | 
| Detect aldosterone synthase aldosterone or angiotensin II (measured by quantitative and qualitative assays Western Blot, mRNA or RT-PCR) in the epicardial fat removed during surgery in patients undergoing a CABG. |  | 1 month | 
| Find a correlation between preoperative plamastic galectin-3 levels and occurrence of postoperative atrial fibrillation |  | 1 month | 
| Find a correlation between preoperative plamastic ngal levels and occurrence of postoperative atrial fibrillation |  | 1 month | 
| Find a correlation between preoperative mitochondrial function and occurrence of postoperative atrial fibrillation |  | 1 month | 
| Find a correlation between preoperative left atrial strain and occurrence of postoperative atrial fibrillation |  | 1 month | 
| Find a correlation between acute renal failure and occurrence of postoperative atrial fibrillation |  | 1 month | 
| Find a correlation between occurrence of postoperative atrial fibrillation and all cause cardiovascular morbimortality |  | 2 years | 
| Find a correlation between occurrence of postoperative atrial fibrillation and length of hospitalisation |  | 1 month | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
aldosterone, cardiac surgery, atrial fibrillation, galectin-3, mitochondria, ngal, acute kidney failure, epicardial fat, right atrial sample