| Purpose 1.To analyze the predictors of thrombotic events in patients with non-valvular atrial fibrillation(AF)in the plateau region(including left atrial ear thrombosis and cardiogenic stroke in this study)except for the entries in the CHA2DS2-VASc score,Whether there are risk factors related to chronic diseases in plateau areas or risk factors related to test indicators,and the value of the screened independent risk factors combined with CHA2DS2-VASc score to predict thrombotic events,so as to identify atrial fibrillation patients with high risk of thrombotic early.In order to explore more appropriate assessment tools and more scientific strategies for the prevention of thromboembolism in patients with non-valvular atrial fibrillation in plateau areas.2.To analyze the status quo of anticoagulation therapy in hospitalized patients with atrial fibrillation in plateau area,and to provide evidence for improving the awareness of the harm of atrial fibrillation among medical staff and patients in this area and standardizing anticoagulation therapy for atrial fibrillation.Method 1.All 157 cases of patients with non-valvular atrial fibrillation(mainly in cardiovascular and neurology departments)who were hospitalized in the internal medicine department of Tibet Autonomous Region People’s Hospital from January2018 to June 2022 were recorded and improved including left atrial appendicular thrombosis assessment,stroke assessment and other related examinations,including 51 cases in the thrombi group and 106 cases in the non-thrombi group.Baseline data between the two groups were compared.Whether there were significant differences in clinical history,cardiac ultrasound indicators,and test indicators,the indicators with statistically significant differences were included in the univariate binary Logistic regression analysis and then the multivariate binary Logistic regression analysis was carried out.Before the multivariate analysis,the variables with statistically significant differences in the univariate analysis were made collinear diagnosis.The selected independent risk factors for thrombotic events were combined with CHA2DS2-VASc score to develop a new score.Finally,the predictive performance of different scores for thrombotic events was evaluated by ROC curve.2.Clinical data of 854 patients who were hospitalized and discharged from Tibet Autonomous Region People’s Hospital from January 2018 to December 2021 and diagnosed as atrial fibrillation,atrial fibrillation or atrial fibrillation were retrospectively collected,and the clinical characteristics and treatment status of patients with atrial fibrillation were analyzed in detail.Results 1.A total of 157 subjects with complete data were included in this study,106 in the non-thrombotic group and 51 in the thrombotic group;There were significant differences in systolic blood pressure,diastolic blood pressure,white blood cells,high-density lipoprotein cholesterol,myoglobin,troponin and triglyceride among the groups,with statistical significance.Age,sex,type of AF,diseases related to AF etiology and altitude,CHA2DS2-VASc score,bleeding score,cardiac color ultrasound structure and function indicators,red blood cells,hemoglobin,hematocrit,platelets,creatinine,uric acid,cholesterol,low-density lipoprotein cholesterol,non-high-density lipoprotein cholesterol,creatine kinase isoenzyme,hypersensitivity There were no significant differences in C-reactive protein,D-dimer,fibrinogen degradation products and fibrinogen.Univariate Logistic regression analysis showed that systolic blood pressure,diastolic blood pressure,white blood cells,high density lipoprotein cholesterol,myoglobin and troponin were risk factors for atrial fibrillation associated thrombosis.Multivariate binary Logistic regression analysis showed that leukocyte and troponin were independent risk factors for atrial fibrillation associated thrombosis.The ROC curve constructed by CHA2DS2-VASc score,white blood cells and troponin showed that they all had predictive ability for atrial fibrillation associated thrombosis.Further,the ROC curve was constructed by combining leukocyte,troponin and CHA2DS2-VASc score,and the AUC value of atrial fibrillation associated thrombosis was increased by 0.26 compared with that of CHA2DS2-VASc score alone.2.A total of 854 hospitalized patients with atrial fibrillation were included in this study.Chronic mountain disease accounted for 7.4% of clinical related factors.The incidence of coronary heart disease and chronic mountain disease in male AF patients was significantly higher than that in female,while the incidence of rheumatic heart disease and congenital heart disease in female AF patients was significantly higher than that in male,and the differences were statistically significant.Rheumatic heart disease and coronary heart disease accounted for the largest proportion of the basic causes of atrial fibrillation in patients under 40 years old.With the increase of age in patients over 40 years old,the proportion of the basic causes of hypertensive heart disease,high grade heart disease and pulmonary heart disease showed an increasing trend,and the proportion of central force failure combined with clinical factors showed an increasing trend while the proportion of high altitude polycythemia showed a decreasing trend.There were differences in the proportion of underlying causes in patients of different ages.Atrial fibrillation complicated with acute coronary syndrome in 68 cases,chronic coronary disease in 55 cases,stenting in 24 cases.There were 160 cases of paroxysmal atrial fibrillation,564 cases of persistent atrial fibrillation and 130 cases of long-term persistent and permanent atrial fibrillation.With the prolongation of the duration of atrial fibrillation,the proportion of anticoagulation therapy showed an increasing trend.There were 781 patients with NVAF.With the increase of embolization score,the proportion of anticoagulant treatment showed an increasing trend.The proportion of anticoagulant treatment in the high-risk group of thromboembolism reached 59.9%,among which the proportion of new oral anticoagulant and warfarin were 49.8% and 10.0%,respectively,while 158 high-risk patients(24.8%)only took antiplatelet drugs.In addition,150 high-risk patients(23.5%)did not receive any anticoagulation/antithrombotic therapy;There were 73 patients with valvular atrial fibrillation,of which rheumatic heart disease(moderate or severe mitral stenosis)accounted for 95.9%(70/73),and mechanical valvular disease accounted for 4.1%(3/73).59 cases(80.8%)were treated with anticoagulation.Left atrial diameter,high altitude pulmonary hypertension and heart failure in patients with valvular atrial fibrillation were significantly higher than those in patients with nonvalvular atrial fibrillation,while age and left ventricular ejection fraction were lower than those in patients with nonvalvular atrial fibrillation.There were significant differences in age,age stratification,sex,type of atrial fibrillation and left atrial diameter between the two groups.Among the different types of atrial fibrillation,persistent atrial fibrillation was the largest.The proportion of females in patients with valvular atrial fibrillation was significantly higher than that of males.With the duration of atrial fibrillation,the proportion of rhythm control drugs showed a decreasing trend,while the use of ventricular rate control drugs showed an increasing trend.Conclusions 1.CHA2DS2-VASc+ leukocyte + troponin score has high predictive value for atrial fibrillation associated thrombosis risk in plateau area,and its predictive ability is better than CHA2DS2-VASc score.2.Rheumatic heart disease and coronary heart disease accounted for the largest proportion of the underlying causes of atrial fibrillation in patients under 40 years of age in plateau areas,while the underlying causes of atrial fibrillation in patients over 40 years of age were mainly hypertensive heart disease,hypergenic heart disease and pulmonary heart disease;The proportion of anticoagulant treatment in 2018-2021 was significantly higher than that in2012-2014;The use of rhythm control drugs in patients with atrial fibrillation needs to be increased. |
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