| Objectives:Atrial fibrillation(AF)is a relatively common clinical arrhythmia that can cause a variety of complications,the most serious of which is ischemic stroke(IS).The risk of IS in patients with nonvalvular atrial fibrillation(NVAF)is about five times higher than non-AF patients,so this type of event is receiving increasing clinical attention.Previous studies have found that N-terminal pro B-type natriuretic peptide(NT-pro BNP),D-dimers and some structural cardiac indicators are strongly associated with the development of AF.Therefore,the purpose of this study was to investigate the potential role and value of NT-pro BNP,D-dimer,and the echocardiographic parameter left atrial diameter(LAD)in identifying patients with NVAF who develop IS,thereby providing some basis for clinical decision making and maximizing patient benefit.Methods:In strict accordance with the inclusion and exclusion criteria,445 patients with NVAF who were hospitalized in the Department of Cardiology and Neurology of the First Affiliated Hospital of Nanchang University from June 2020 to July 2022 were selected consecutively.They were divided into the NVAF(309 cases)and NVAF with stroke(136 cases)groups according to whether acute ischemic stroke(AIS)occurred at admission.The clinical data of the enrolled patients were collected,and the demographic data and relevant clinical laboratory indices were compared between the two groups.Multivariate logistic regression was used to analyze the odds ratio(OR)of NT‐pro BNP,D‐dimer,and LAD for IS.Receiver-operator characteristic curves(ROC)were plotted to determine the predictive value of NT-pro BNP,D-dimer and LAD alone and in combination in identifying the occurrence of IS in NVAF patien.Results:1.NT-pro BNP,D-dimer,Hcy,TC,TG,LDL-c,Hs T,CRP,FIB,LAD and LVDd were higher in the NVAF combined stroke group than in the control group;LVEF and history of anticoagulant use were lower than in the control group(P<0.05).There were no significant changes in age,gender,BMI,history of smoking,history of hypertension,history of diabetes,history of CHD,history of cerebral infarction,HDL-c,UA,Cr,and history of antiplatelet drug use between the two groups(P>0.05).2.ROC analysis showed that the area under the curve(AUC)of NT‐pro BNP,D-dimer,LAD and CHA2DS2-VASC scores were [0.80,95%CI(0.76-0.84),0.77,95%CI(0.72-0.85),0.75,95%CI(0.71-0.80),0.70,95%CI(0.65-0.75),P<0.01].The optimal cut-off points for NT-pro BNP,D-dimer and LAD levels were 715.0pg/ml,0.515ng/ml and 38.5mm,respectively.3.Compared with the groups with low NT‐pro BNP,D-dimer and LAD cut-off values,the incidence of IS events in the groups with high NT‐pro BNP,D-dimer and LAD cut-off values increased significantly(72.1% vs 25.9%,82.4% vs 38.5%,90.4%vs 44.7%,P<0.01).4.The combined score of NT‐pro BNP,D‐dimer,and LAD improved the predictive efficacy of the single index,with an AUC of 0.846(95%CI:0.81–0.88,P<0.01),sensitivity of 77.2%,and specificity of 76.4%.Conclusions:1.Serum NT‐pro BNP,D-dimer and LAD are independent risk factors for IS in NVAF patients.2.Serum NT‐Pro BNP,D-dimer and LAD have important value in predicting the risk of IS in NVAF patients,which improves the predictive effect of single index.3.Compared with the CHA2DS2-VASC score,the combined index has higher sensitivity and specificity,which may help to improve the CHA2DS2-VASC score. |
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