| 1.BackgroundWith the aging of the world’s population and the progress of urbanization,the incidence and prevalence of atrial fibrillation and heart failure are increasing.The two are often interdependent and promote each other,which seriously affect the prognosis.Platelet/lymphocyte ratio(PLR)is a comprehensive response of thrombotic inflammatory pathways,which has been shown to be associated with the occurrence of atrial fibrillation.The aim of this study is to investigate the clinical value of PLR combined with left atrial diameter(LAD)in predicting the occurrence of AF in heart failure patients and heart failure patients with AF.2.PurposeA retrospective study of patients with heart failure was conducted to investigate the relationship between a novel inflammatory indicator PLR and the occurrence of atrial fibrillation,as well as the predictive ability of PLR combined with LAD for atrial fibrillation in patients with heart failure.3.Method and objectsA total of 110 patients with heart failure admitted to the Department of Cardiology of Nanfang Hospital,the First Affiliated Hospital of Southern Medical University from August 2020 to August 2022-August were selected.According to the presence or absence of AF,they were divided into two groups:heart failure with AF group and heart failure without AF group.Routine blood test(PLR),glycosylated hemoglobin(HbAlc),creatinine(CR),low density lipoprotein(LDL-C),C-reactive protein(CRP)and N-terminal B-type diuretic peptide(NT-BNP)were measured after admission.Transthoracic echocardiography was performed,and cardiac ejection fraction(EF),left atrial diameter(LAD),left ventricular end-diastolic diameter(LVIDd),left ventricular end-systolic diameter(LVIDs)and left ventricular mass(LVMW)were collected.Univariate logistic regression analysis was used to analyze the risk factors of atrial fibrillation in patients with heart failure,and multivariate logistic regression analysis was used to adjust the confounding factors to evaluate the risk factors of atrial fibrillation in patients with heart failure.ROC curve analysis was used to evaluate the clinical value of PLR,LAD and PLR combined with LAD in predicting the occurrence of AF.4.Result(1)There were significant differences in age,coronary heart disease,use of anticoagulants,anti-platelet drugs,digoxin and diuretics between the AF group and the control group at baseline(P<0.05).There were significant differences in PLR,Na,CHOL,LAD and degree of mitral regurgitation between the two groups by biochemical routine and ultrasound examination(P<0.05).(2)Multivariate regression analysis showed that LAD was significantly associated with atrial fibrillation in patients with heart failure(OR=1.224,95%CI 1.106-1.354,P<0.001).The effect of age on AF was still statistically significant(OR=1.076,95%CI 1.027-1.128,P<0.05).PLR was associated with the occurrence of AF(OR=1.011,95%CI 1.000-1.022,P<0.046).(3)ROC curve analysis showed that LAD had the highest predictive efficiency for the occurrence of AF(AUC=0.791),age and PLR had the lowest predictive efficiency(AUC=0.672,0.694).LAD combined with other indicators could significantly improve the prediction performance.The AUC of LAD combined with age was 0.812,the AUC of LAD combined with PLR was 0.832,the AUC of age combined with PLR was the lowest(0.761),and the AUC of the combination of the three indicators was the highest(AUC=0.858,sensitivity was 88%,specificity was 76%).Combined prediction can effectively improve the prediction efficiency.5.ConclusionLAD,age and PLR are all independent risk factors for AF in patients with heart failure.Among them,LAD is the most powerful independent risk factor for AF and has a high predictive value.PLR also has a certain predictive value for the occurrence of AF,but it cannot be used as the main indicator.The combination of multiple indicators can better predict the occurrence of AF.This study has certain limitations and needs to be confirmed by more studies. |
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