Predictive Effect Of Monocyte To High-density Lipoprotein Ratio On Stroke In Patients With Nonvalvular Atrial Fibrillation

PurposeThrough the analysis of atrial fibrillation（AF）in the non valvular disease general clinical characteristics,compared to pure atrial fibrillation and atrial fibrillation complicating acute cerebral apoplexy patients monocytes/high-density lipoprotein cholesterol（MHR）and other differences in the laboratory indexes,discusses such indicators for prediction of acute stroke patients with nonvalvular atrial fibrillation..MethodsRetrospective analysis is applied in this study,collected between September2017 and September 2020 in the second affiliated hospital of guangzhou medical university cardiovascular internal medicine or nerve internal medicine diagnosis and treatment of 250 patients with nonvalvular atrial fibrillation,according to whether the acute stroke will be divided into pure nonvalvular atrial fibrillation group and complicating acute cerebral apoplexy group（group A,B）,the statistics of each group general clinical data（name,gender,age,blood pressure,heart rate,smoking history,and admission CHADS₂score,CHA₂DS₂-VASc score,etc.）and the laboratory biochemical indexes（monocytes,high-density lipoprotein（HDL）,High-density lipoprotein）,MHR,cholesterol,platelet count,creatinine,troponin,etc.),and statistically significant indicators were screened out.Logistic regression analysis was used to analyze the factors that might predict stroke,and the assessment of MHR and left atrial diameter was included on the basis of CHA2DS2-VASC score to try to establish a new stroke risk scoring method（VASCML score）.Receiver Operating Characteristic（ROC）curve was plotted to analyze and compare the predictive ability of CHADS2 score,CHA2DS2-VASC score and the new scoring method for stroke prediction in patients with atrial fibrillation with non-valvular disease.ResultsComparison between the simple atrial fibrillation group and the atrial fibrillation combined with stroke group showed significant differences in monocyte count,high density lipoprotein,CHA₂DS₂-VASC score,CHADS₂score,MHR,platelet,left atrial diameter,admission diastolic blood pressure and apolipoprotein A between the two groups（P<0.05）.Binary logistic regression analysis of significantly different factors showed that monocyte count,MHR,platelets,lipoprotein A,and left atrial diameter were independently associated with stroke risk（P<0.05,OR>1）.The ability of CHADS2 score,CHA2DS2-VASC score,VASCML score,monocyte count and MHR to predict stroke in patients with atrial fibrillation was compared by the recipient operating characteristic curve.The areas under the receiver operating characteristic curve were 0.569（95%CI:0.498--0.640）,0.623（95%CI:0.554--0.692）,0.678（95%CI:0.612--0.745）,0.666（95%CI:0.600--0.732）and 0.717（0.654-0.780）respectively.Conclusion1.MHR is an independent risk factor for acute stroke in patients with NVAF.2.Monocytes,platelets,admission diastolic blood pressure,and left atrial diameter are associated with acute stroke in patients with NVAF,and are risk factors for new stroke in patients with AF.3.Comparing the CHADS2 and CHA2DS2-VASC scores,the new scoring method（VASCML）can more accurately assess the risk of stroke in patients with atrial fibrillation.