Relationship Between Mean Platelet Volume And Left Atrial/Left Atrial Appendage Thrombosis In Non-Valvular Atrial Fibrillation

Research Background:Atrial fibrillation is the most common arrhythmia in clinical practice.It's prevalence and morbidity have increased significantly compared with the past few decades.It has become a popular cardiovascular disease and seriously increases the social medical burden.Non-valvular atrial fibrillation is the most important type of atrial fibrillation and is the focus of the research of atrial fibrillation.Atrial fibrillation is associated with a high risk of thromboembolism.The majority of thromboembolism caused by atrial fibrillation is caused by the left atrium thrombosis,especially the left atrial appendage thrombosis.Therefore,it is of great clinical significance to find the risk factors of left atrial/left atrial thrombosis in atrial fibrillation.In addition to reflecting platelet size,the average platelet volume is also an indicator of platelet function and activation.Large platelets have higher activity and reactivity than small platelets,can release more platelet particles and prothrombotic active substances,express more glycoproteins with adhesion function on the surface,interact with collagen,ADP,and vWF more quickly and accelerate platelet aggregation,and the sensitivity of large platelets to prostacyclin inhibiting platelet aggregation is reduced,all of which promote thrombosis.In recent years,studies have shown that the average platelet volume is a potential biomarker for the risk and prognosis of many cardiovascular and cerebrovascular diseases.At the same time,Studies have also shown that the average platelet volume of patients with atrial fibrillation is significantly higher than that of non-atrial fibrillation patients.However,whether the average platelet volume is further involved in the thrombosis of atrial fibrillation,the related research is few,and the results are inconsistent and controversial.What's more,there is no relevant data in domestic journals.Research purposes:To explore the risk factors of left atrial/left atrial appendage thrombosis in non-valvular atrial fibrillation,especially the relationship between mean platelet volume and thrombosis of non-valvular atrial fibrillation,and the predictive value ofrisk factors for thrombosis of atrial fibrillation.Research objects and methods:This study included 208 patients with non-valvular atrial fibrillation who were admitted to the First Affiliated Hospital of Nanchang University from January 2014 to December 2018,and who met the inclusion criteria and exclusion criteria.According to the results of transesophageal echocardiography and the presence or absence of left atrial/left atrial appendage thrombosis,the included subjects were divided into a thrombus group(n=20)and a non-thrombosis group(n=188).The general data and laboratory examinations of the two groups of patients were compared,and univariate and multivariate logistic regression analysis were performed.The obtained risk factors were analyzed by ROC curve to understand their predictive value.Result:(1)General data and laboratory examination comparison: The thrombus group's age,proportion of congestive heart failure,CHA2DS2-VASc score,uric acid,creatinine,mean platelet volume were higher than the non-thrombosis group,and the difference was statistically significant(P<0.05).(2)Univariate logistic regression analysis: Mean platelet volume,age,congestive heart failure,stroke/TIA,vascular disease,CHA2DS2-VASc score,uric acid,creatinine were associated with left atrial/left atrial thrombosis in non-valvular atrial fibrillation(P<0.05),and they were all risk factors.(3)Multivariate logistic regression analysis: Mean platelet volume,CHA2DS2-VASc score,creatinine and congestive heart failure were risk factors for left atrial/left atrial appendage thrombosis in non-valvular atrial fibrillation(P<0.05).(4)ROC curve: The area under the ROC curve of MPV was 0.686,the area under the ROC curve of the CHA2DS2-VASc score was 0.759,the area under the ROC curve of Cr was 0.684,and the area under the ROC curve of congestive heart failure was 0.667.Conclusion:Mean platelet volume,CHA2DS2-VASc scores,congestive heart failure and creatinine were risk factors for left atrial/left atrial appendage thrombosis in patients with non-valvular atrial fibrillation.