| Research background and purpose:Atrial fibrillation(AF)is a common arrhythmia that is considered to be one of the main causes of stroke,heart failure,dementia,and sudden death.With the aging of the population,the number of patients with atrial fibrillation is expected to increase dramatically in the next few years.A study by Sumeet S.et al pointed out that there were approximately 33.5million patients with AF worldwide in 2010 and that by 2050,the global number will more than double.The incidence of atrial fibrillation in our country is 0.77%.Due to the effective and regular atrial contraction and diastolic dysfunction,The bloodstream of the left atrial(LA)or left atrial appendage(LAA)in atrial fibrillation is slow,blood stasis or even thrombosis.The shedding of thrombus may cause systemic embolism,stroke,etc.,which will seriously affect the quality of life of patients with atrial fibrillation and threaten their lives.Therefore,it is necessary to identify people at high risk of thrombosis early and take corresponding measures such as anticoagulation to avoid thrombosis,thereby reducing the occurrence of stroke and thrombotic events.Although there are various types of scoring systems,such as CHADS2 and CHA2DS2-VASc scoring,CHA2DS2-VASc is a risk scoring system used to identify anticoagulant indications in patients with non-valvular atrial fibrillation.This risk score includes congestive heart failure/systolic dysfunction(left ventricular ejection fraction <40%),hypertension,age 75 years or older,diabetes,history of stroke,transient ischemic attack or embolism,and myocardial infarction or history of aortic plaque,peripheral arterial disease,between 65 and 74 years old,and female.However,the evaluation value of the scoring system is still limited,and it does not include all the risk factors that cause left atrial appendage(LAA)thrombosis.Therefore,this study will further explore the related risk factors which may lead to left atrial appendage thrombosis,so as to intervene in high-risk patients as soon as possible to reduce the occurrence of stroke events.Methods:The 51 patients with non-valvular atrial fibrillation who underwent esophageal ultrasound and clearly diagnosed left atrial appendage thrombosis in the internal medicine group of the Cardiovascular Disease Diagnosis and Treatment Center of Jilin University First Hospital from January 2015 to December 2018 were selected as the experimental group,according to the same period admission principle 153 patients with non-valvular atrial fibrillation who underwent esophageal ultrasound and no left atrial appendage thrombosis(positive cases and negative cases were matched 1:3)were selected as the control group during the same period.Relevant data were collected and organized from our hospital’s case system,inspection,inspection system and medical record management department,such as gender,age,coronary heart disease(CHD),hypertension,diabetes,heart failure,smoking history,CHA2DS2-VASC,renal function,drinking,D-Dimer,type B-brain natriuretic peptide,neutrophils,lymphocytes,neutrophils/lymphocytes,platelets,platelet distribution width,red blood cells(RBC),hemoglobin,INR,fibrinogen,serum albumin,mitral Valve regurgitation,left ventricular ejection fraction(LVEF),left atrial diameter(LAD)etc.We conducted a retrospective analysis and research.Univariate analysis and multivariate Logistic regression analysis were conducted on the indicators which may have an impact on the occurrence of left atrial appendage thrombosis.Finally,we would obtain the indicators which are clearly related to the left atrial appendage thrombosis.The receiver operating characteristic curve(Receiver operating characteristic curve,ROC curve)was used to evaluate the predictive value of the above indicators.The Yorden index were calculated to find the best prediction threshold of each index for left atrial appendage thrombosis.The above statistical analysis is carried out using SPSS26.0 software package.Results:1.The study included a total of 204 patients,51 were included in the experimental group and 153 were included in the control group.2.Analysis of baseline data: gender,age,coronary heart disease,hypertension,diabetes,heart failure,renal function,smoking and drinking of the experimental group and the control group.There was no significant difference in gender,age,coronary heart disease,hypertension,diabetes,renal function,smoking and drinking between the two groups.The presence or absence of heart failure in the two groups was statistically significant(P<0.05).The proportion of patients with heart failure in the left atrial appendage thrombosis group(49%)was higher than that in the non-left atrial appendage thrombosis group(20.9%).3.Comparison and analysis of hematology,echocardiography,CHA2DS2-VASC and other related indicators: 1),single factor analysis:D-dimer,lymphocytes,platelets,Platelet distribution width(PDW),red blood cells,hemoglobin,fibrinogen,and serum albumin were not significantly different(P>0.05).The differences in mitral regurgitation,left ventricular ejection fraction,left atrial diameter,CHA2DS2-VASC,B-brain natriuretic peptide,neutrophils,neutrophils/lymphocytes,and INR between the two groups were statistically different significance(P<0.05).2)Multivariate Logistic regression analysis showed that the absolute value of neutrophils(95%CI: 1.001-1.587 P=0.049)and the inner diameter of the left atrium(anteroposterior diameter)(95%CI:1.189-1.421 P<0.001)are important factors for left atrial appendage thrombosis in patients with non-anticoagulated non-valvular atrial fibrillation.3)The receiver operating characteristic(ROC)curve evaluates the predictive value of neutrophils and left atrial diameter(anteroposterior meridian)on the risk factors of left atrial appendage thrombosis in patients with non-valvular non-anticoagulant atrial fibrillation.The results showed that the area under the ROC curve for neutrophils predicting left atrial appendage thrombosis was 0.606,and the best predictive value was 4.235 according to the Youden index;the area under the ROC curve for predicting left atrial appendage thrombosis was0.816 by the inner diameter of the left atrium,and according to the Youden index,the best predictive value was 40.5mm。The area under the ROC curve for predicting left atrial appendage thrombosis was 0.825,when we combined neutrophils with the left atrial inner diameter to predict left atrial appendage thrombosis。Conclusions:1.Heart failure,mitral regurgitation,left ventricular ejection fraction,left atrial diameter,CHA2DS2-VASC,B-brain natriuretic peptide,neutrophils,neutrophils/ lymphocytes and INR is related with left atrial appendage thrombosis.2.Neutrophils and left atrial diameter are important factors for predicting left atrial appendage thrombosis in patients with non-valvular and non-anticoagulated atrial fibrillation.3.The best indicator that affects left atrial appendage thrombosis is neutrophils combined with left atrial diameter,followed by left atrial diameter,neutrophils have the lowest predictive value.4.Left atrial appendage thrombosis is more common in patients with enlarged left atrium diameter.It is one of the independent predictors of left atrial appendage thrombosis.For patients with increased left atrial diameter,especially those with other risk factors for thromboembolism,even if they do not meet the anticoagulation criteria,these patients may need to be more aggressively resisted.Coagulation treatment. |
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