Correlation Between Abnormal Uric Acid Metabolism And Left Atrial Thrombosis In Patients With Atrial Fibrillation

BackgroundAtrial fibrillation is one of the most common arrhythmias.Long–term atrial fibrillation can easily lead to the formation of left atrial thrombi(LAT).LAT is the main source of embolism in patients with atrial fibrillation.The current Guidelines recommend using CHA2DS2–VASc scores to assess the risk of embolism in patients with atrial fibrillation,and those with high risk should be treated with oral anticoagulants.However,in clinical practice,patients with low–risk still have embolic events;and research suggests that risk factors for embolic events in atrial fibrillation are not limited to CHA2DS2–VASc scores.Therefore,it is necessary to deeply explore the risk factors of LAT and optimize its risk assessment strategy.Previous studies have suggested that uric acid may be a risk factor for LAT,but more clinical evidence is needed to prove it.PurposesThis single–center,retrospective study will(1)analyze the correlation between uric acid and LAT formation in patients with atrial fibrillation,(2)assess other risk factors that may potentially affect the formation of LAT,and(3)explore significance of oral anticoagulation for LAT prevention.It aims to provide an optimized strategy for embolization risk assessment of atrial fibrillation,and provide more clinical evidence for the anticoagulation management of patients with atrial fibrillation.MethodsIn this study,abnormal uric acid metabolism(AbUA)is used as a factor to evaluate the correlation between uric acid and LAT formation.We retrospectively included all patients with non–valvular atrial fibrillation who were admitted to our hospital and successfully received transesophageal echocardiography(TEE)examinations from January 1,2014 to December 31,2019.Basic information,indicators in CHA2DS2–VASc scores,indicators related to LAT formation in previous reports,and main results of transthoracic echocardiography and TEE were collected.The observation endpoints were LAT and spontaneous echo contrast(SEC)reported by TEE.Through logistic regression analysis,propensity score matching analysis,receiver operating characteristic curve analysis to explore the risk of LAT formation in patients with atrial fibrillation,clarify whether uric acid is an independent risk factor for LAT formation,and analyze other potential risk factors;the main results and uncertain results will be further verified in the subgroup of patients with atrial fibrillation and hypertension;under different risk stratification strategies,explore whether oral anticoagulation is beneficial to LAT prevention,and analyze clinical characteristics in patients with peri–ablation embolism,discuss the significance of anticoagulation for the prevention of LAT.ResultsThe results showed that(1)AbUA is an independent risk factor for LAT formation in patients with atrial fibrillation,and incorporating AbUA into the CHA2DS2–VASc score can optimize the model’s predictive effect on LAT formation;(2)overweight/obesity may be an independent risk factor for LAT formation in patients with AF;(3)dilated cardiomyopathy is significantly correlated with LAT formation in patients with atrial fibrillation;(4)the risk factors for LAT and SEC may be different,and left atrial enlargement is not an independent risk factor for LAT formation in patients with atrial fibrillation,but may be an independent risk factor for SEC;(5)for patients with atrial fibrillation with a CHA2DS2-VASc score of 0–2,oral anticoagulant therapy cannot benefit the prevention of LAT,however,patients who have not found LAT in TEE are still at risk of embolic events.ConclusionsAbUA is an independent risk factor for LAT formation in patients with atrial fibrillation.Incorporating AbUA into the CHA2DS2–VASc score can optimize the predictive effect of this model on LAT formation.