The Value Of Left Atrial Structural And Functional Parameters Combined With Cardiac Biomarkers In Predicting Left Atrial Spontaneous Echo Contrast In Patients With Non-valvular Atrial Fibril Llation

Objective:To investigate the relationship between the structure,function of left atrial as well as cardiac biomarkers and left atrial spontaneous echo contrast?SEC?in patients with non-valvular atrial fibrillation?NVAF?,and to evaluate its predictive value for left atrial SEC.Methods:Ninety patients with NVAF who were hospitalized in our hospital from March 2017 to December 2018 for radiofrequency ablation of atrial fibrillation were divided into two groups according to transesophageal echocardiography:SEC-positive group?40 cases?with the presence of left atrial SEC and SEC-negative group?50 cases?without left atrial SEC.Forty patients admitted at the same time and excluding cardiovascular disease and its high-risk factors and acute infectious diseases were selected as control group according to gender and age matching.Clinical and laboratory data were collected,including medical history,cardiac troponin I?cTnI?,pro-brain natriuretic peptide?pro-BNP?,etc.And CHA₂DS₂-VASc scores were calculated.Left atrial dimension?LAD?,left atrial maximum volume index(LAVI_max),left atrial minimum volume index(LAVI_min),the mitral inflow early-diastolic peak velocity?E?,the mitral annulus tissue Doppler early-diastolic peak velocity?E_m?,pulmonary venous systolic peak velocity?S?and other parameters were measured by transthoracic echocardiography?TTE?.Then calculated the left atrial ejection fraction?LAEF?and E/E_m.Finally the clinical material were compared between the SEC-positive and SEC-negative group,TTE parameters and cardiac biomarkers levels were compared among the three groups,and ROC curve was used to evaluate the diagnostic efficiency of predicting left atrial spontaneous echo contrast?SEC?.Results:Compared with control group,the value of LAD,LAVI_max,LAVI_min and pro-BNP levels were significantly increased in SEC-negative group and SEC-positive group?all P<0.05?,and that in SEC-positive group was significantly higher than that in SEC negative group?all P<0.05?;Compared with control group,the value of LAEF and S were significantly decreased in SEC-negative group and SEC-positive group?all P<0.05?,and that in SEC-positive group was significantly lower than that in SEC negative group?all P<0.05?.E/E_m and cTnI in SEC-negative group and control group did not show statisticant difference?all P>0.05?,but presented a significant increase in SEC-positive group compared with control group and SEC-negative group?all P<0.05?.Compared with SEC-negative group,CHA₂DS₂-VASc scores in SEC-positive group showed a significant increase?P<0.05?.And the AUC,sensitivity and specificity of CHA₂DS₂-VASc scores for predicting left atrial SEC were 0.71?95%CI:0.60⁰.82?,62.0%and 70.0%,respectively.When left atrial structural and functional parameters?LAVI and LAEF?combined with cardiac biomarkers?cTnI and pro-BNP?,the AUC,sensitivity and specificity for predicting left atrial SEC were 0.91?95%CI:0.84⁰.97?,74.0%and 100.0%respectively,both enhanced when compared with CHA₂DS₂-VASc scores alone?P<0.05?.Conclusion:Left atrial enlargement,decreased reserve function,elevated of left ventricular filling pressure and cardiac biomarkers are associated with left atrial SEC in patients with NVAF.CHA₂DS₂-VASc scores can be used for perdicting left atrial SEC,and has moderate predictive value.Left atrial structural and functional parameters?LAVI and LAEF?combined with cardiac biomarkers?cTnI and pro-BNP?provide significant increments in prediction of left atrial SEC,and it may provide a useful supplement for patients with NVAF to improve stroke risk stratification and anticoagulation therapy.