Correlation Of Homocysteine Levels With The Development Of Pulmonary Embolism In Patients With Non-valvular Atrial Fibrillation

Objective:Atrial fibrillation(AF)is one of the most common types of cardiac arrhythmias in the clinical setting,due to the altered hemodynamics and hypercoagulability of the body,which promotes thrombus formation.It has been shown that thromboembolism due to AF is not only embolism of the body circulation,but also pulmonary embolism(PE).Pulmonary embolism is a common and critical clinical condition with a high mortality rate.Some patients with pulmonary embolism have an insidious onset and lack of specificity in clinical manifestations,which have many similarities with those of atrial fibrillation and are easily missed and misdiagnosed,resulting in delayed treatment.Elevated homocysteine(Hcy)levels are an independent risk factor for cardiovascular disease,as well as for venous thrombosis and pulmonary embolism.However,it is not clear whether elevated homocysteine levels increase the risk of pulmonary embolism in patients with atrial fibrillation.Therefore,this study investigated the relationship between homocysteine levels and the risk of pulmonary embolism in patients with non-valvular atrial aibrillation(NVAF),and explored the factors associated with pulmonary embolism in patients with non-valvular atrial fibrillation to provide useful reference for clinical detection of occult pulmonary embolism,and early intervention and prevention.Methods:The study population was inpatients admitted to the First Affiliated Hospital of Nanchang University and the Second Affiliated Hospital of Nanchang University between January 2017 and December 2022,and those eligible were screened strictly according to inclusion and exclusion criteria,and 78 patients with non-valvular atrial fibrillation combined with pulmonary embolism(NVAF combined with PE group)and 88 patients with non-valvular atrial fibrillation alone without pulmonary embolism(simple NVAF group)were selected.General information,past history,laboratory tests,imaging tests,New York Heart Association(NYHA)cardiac function classification at admission,CHA2DS2-VASc score and simplified pulmonary embolism severity index(s PESI)score were collected for statistical analysis in both groups.Independent risk factors for the development of pulmonary embolism in patients with nonvalvular atrial fibrillation were examined using univariate and multivariate logistic regression analysis.Subject operating characteristic(ROC)curves were plotted to determine the index threshold,sensitivity and specificity.p < 0.05 was considered a statistically significant difference.Results:1.Compared with the simple NVAF group,the NVAF combined with PE group had worse cardiac function at admission(p < 0.05).2.The NVAF combined PE group had higher coefficient of variation in red blood cell distribution width,D-dimer,Hcy,and uric acid levels compared to the simple NVAF group,but the e GFR value was lower than that of the NVAF combined PE group(p < 0.05).3.Compared with the simple NVAF group,the NVAF combined with PE group had a larger right atrial internal diameter and right ventricular internal diameter,a wider pulmonary artery internal diameter,and a lower left ventricular ejection fraction(p < 0.05).4.Multi-factor logistic regression analysis: increased risk of pulmonary embolism in patients with non-valvular atrial fibrillation was strongly associated with D-dimer and Hcy levels(p < 0.05).5.ROC curve: the area under the curve of HCY and D-dimer for NVAF combined PE diagnosis is 0.707 and 0.908,respectively,which has a certain predictive value for the risk of pulmonary embolism.The area under the curve of HCY combined with D-dimer for the diagnosis of NVAF combined with PE was0.909,but the sensitivity was significantly higher than that of Hcy and D-dimer,which was better than the prediction of pulmonary embolism risk by a single index.Conclusions:In patients with non-valvular atrial fibrillation,homocysteine and D-dimer levels are strongly associated with the development of pulmonary embolism and can be tentatively considered as risk factors for the development of pulmonary embolism in patients with NVAF.