Risk Factors Of Carotid Atherosclerosis In Patients With Atrial Fibrillation

ObjectiveWe aimed to explore the risk factors of carotid atherosclerosis in patients with atrial fibrillation(AF),and to improve the attention of clinicians to AF pateints with carotid atherosclerosis,therefore,to contribute the risk stratification of stroke in patients with AF.Methods209 patients with atrial fibrillation were collected from January 2016 to December 2018 in Department of Cardiology,Second Hospital of Tianjin Medical University.Multivariate logistic regression was used to analyze the risk factors of carotid atherosclerosis in patients with atrial fibrillation.Results1.In 209 AF patients,153 patients have carotid intima-media thickness(cIMT)≥0.9mm,of which 88(57.5%)were male.The mean age of the patients from cIMT≥0.9mm group was 70.60±9.73 years old,which was significantly higher than that of cIMT<0.9mm group(66.05±11.34 years old),the difference was statistically significant(P=0.005).There were 122(79.7%)patients with hypertension in the group with cIMT≥0.9mm,which was significantly higher than that in the group with cIMT<0.9mm [33(58.9%),P=0.002].There were 95 cases(62.1%)with coronary heart disease in cIMT≥0.9mm group,which were higher than 22 cases(39.3%)in group with cIMT<0.9mm(P=0.003).There were 39(25.7%)patients with stroke in the group with cIMT≥0.9mm,which was significantly higher than that in the group with cIMT<0.9mm [6(10.7%),P=0.020].Persistent/permanent AF was found in65(42.5%)patients with cIMT≥0.9mm,which was higher than that in 18(32.1%)patients with cIMT<0.9mm,but there was no significant difference(P=0.176).The mean CHA2DS2-VASc score of the patients from cIMT≥0.9mm group was 3,which was higher than that of cIMT<0.9mm(2,P=0.002).100 cases(65.8%)were treated with ACEI/ARB drugs in patients with cIMT≥0.9mm,which was significantly higher than that in 28 cases(50.0%,P=0.038)with cIMT<0.9mm.The NT-proBNP of 520(145,1309)ng/L in the patients with cIMT≥0.9mm was significantly higher than thatin the cIMT<0.9mm group[207(94,650)ng/L,P=0.012].2.In 209 AF patients,158 had carotid plaques,87(55.1%)were male.The mean age of AF patients with carotid plaques was 71.73±9.41 years old,which was significantly higher than that of AF patients without carotid plaques(62.10±9.82 years old),the difference was statistically significant(P<0.001).There were 100(63.3%)patients with coronary heart disease in the AF patients with carotid plaques,which was significantly higher than that in those without carotid plaques [17(33.3%),P<0.001].There were 38 cases(24.2%)with stroke in the group with carotid plaques,which was higher than that in the group without carotid plaques[7(13.7%)],but there was no significant difference(P=0.114).There were 120 cases(75.9%)with hypertension in carotid plaques group,which was higher than 35 cases(68.6%)in group without carotid plaques,but there was no significant difference(P=0.299).There were 68 cases(43.0%)with patients with persistent/permanent AF in carotid plaques group,which was higher than 15 cases(29.4%)in group without carotid plaques,but there was no significant difference(P=0.084).The mean CHA2DS2-VASc score of patients with carotid plaques was 3,which was higher than that of those from non-carotid plaques(2,P=0.002).64 cases(40.8%)were treated with antiplatelet drugs in patients with carotid plaques,which was significantly higher than that in 11 cases(21.6%,P=0.013)without carotid plaques.The mean LVEF in the group with carotid plaques was 60%,which was lower than that in the group without carotid plaques [62%,P=0.024)].The LAD in carotid plaques group was 42.6(38.9,46.4)mm,which was higher than that in non-carotid plaques group[49.4(36.6,44.6)mm,P=0.030].The D-dimer of 405.0(263.2,775.3)ng/ml,in the patients with carotid plaques was significantly higher than that in the non-carotid plaques group [263.6(181.3,597.3)ng/ml],and the difference was statistically significant(P=0.003).The NT-proBNP of 451(151,1294)ng/L in the patients with carotid plaques was significantly higher than that in the non-carotid plaques group[279(74,823)ng/L],and the difference was statistically significant(P=0.034).3.In multivariate logistic regression analysis,age was the only independent risk factor for carotid plaques(OR=1.145;95%CI=1.057-1.240,P=0.001)in patients with AF.Conclusion1.The incidence of carotid plaques in patients with atrial fibrillation was 75.6%,of which the average age was 71.7 years old and 44.9% was female.2.CHA2DS2-VASc score and the incidence of stroke,coronary heart disease and hypertension were higher in AF patients with carotid atherosclerosis,and the prevalence of persistent / permanent AF was also higher.3.In multivariate logistic regression analysis,age was the only independent risk factor for carotid atherosclerosis in patients with AF.