| Background and ObjectiveThromboembolism is the most popular complication of atrial fibrillation (AF) which is the most common sustained arrhythmia. Non-valvular atrial fibrillation (NVAF) accounts for 87% among all of AF. The year incidence of NVAF patients in stroke is about 5%, so, the therapy of NVAF is concerned. Large-scale randomized clinical trial results show that anticoagulant therapy can significantly reduce the thromboembolism incidence in patients with NVAF, improve the quality of life. However, anticoagulant therapy brings another problem at the same time:increased risk of bleeding, especially the bleeding of important part will bring life-threatening. So, it appears especially important to prevent thromboembolism by evaluating the risk of embolism, screening high-risk patients and anticoagulation treatment.Home and abroad have done a lot of research on selecting high-risk thromboembolism NVAF patients, such as clinical risk factors, echocardiography, 64-slice spiral CT, electrocardiogram(ECG) and blood thrombosis markers, they refer the age, hypertenion, left atrial dimension (LAD), amplitude of fibrillation wave, timing of fibrillation wave, f-f interval, D-dimer(D-D), etc. However, most of them studied from the signal fator, and some of their clinical use is very limited for their technical difficulty and poor availability. Anymore, the reports about the ECG are few. In the present study, we intent to test the simple clinical indicators LAD, fibrillation wave in electrocardiogram (amplitude of fibrillation wave, timing of fibrillation wave, f-f interval) and D-D, and to explore their clinical value for evaluating the risk of thromboembolism events in patients with NVAF in the signal and multivariate fators.Patients and Methods93 patients with NVAF were divided into thromboembolic events group (n=32) and non-thromboembolic events group (n=61) according to the occurrence of thromboembolic events. All patients underwent transthorscic echocardiography (TTE) to detect LAD, a standard ECG to detect the amplitude of fibrillation wave, timing of bibrillation wave and f-f interval. D-dimer were determined with enzyme-linked immunosorbent assay (ELISA). the results of the two groups were statistically analyzed:single factor analysis, Logistic regression analysis, independent risk factor for the evaluation of diagnosis, single factor and multiple factors in the evaluation of the thromboembolic events in patients with NVAF.Results1. Enrolled 93 patients with NVAF, thromboembolic events group (n=32) and non-thromboembolic events group (n=61), there were no significant differences in sex, age, duration of AF and underlying diseases between the two groups (P> 0.05);2. The LAD,the amplitude of fibrillation wave, timing of fibrillation wave, f-f interval and D-D were significant different between the two groups:The LAD was significant larger in the thromboembolic events group than that in non-thromboembolic events group (48.03±6.31mm vs 43.02±7.41mm, P<0.05), amplitude of fibrillation wave was significant shorter than the latter (0.077±0.036mv vs 0.090±0.026mv, P<0.05), timing of fibrillation wave was significant shorter than the latter (0.099±0.024s vs 0.112±0.021s, P<0.05), f-f interval was significant shorter than the latter (0.127±0.039s vs 0.150±0.035s, p<0.05);and the D-D is significant higher than the latter (0.52±0.61mg/L vs 0.23±0.35mg/L,P<0.05).3. Multiple Logistic regression analysis for the thromboembolic events in NVAF patients. The results revealed:the OR values of age, AF duration, LAD, and D-D were larger than 1, they were the risk factors of the thromboembolic events in NVAF patients; the OR values of amplitude of fibrillation wave, timing of fibrillation wave, f-f interval were smaller than 1,they were the protective factors. According to the P value, indicating the exclusion of the influence of other factors, the independent risk factors of thromboembolic events in NVAF patients were:LAD increased (P=0.005), timing of fibrillation wave shortened (P=0.012), D-D increased (P=0.020).4. ROC curve of the data showed:the area under the curve of LAD, timing of fibrillation wave, D-D were 0.898,0.548,0.901, P values were<0.05. As the risk factors of thromboembolic events in NVAF patients, the evaluation indicators had some diagnostic value; the area under the curve of D-D>0.9, P <0.01, its diagnostic value was high, the area under the curve of LAD was between 0.7 and 0.9, the diagnostic value of medium, the area under the curve of timing of fibrillation wave<0.7, the diagnostic value was lower. When the correct diagnosis index (r=sensitivity+specificity-1) was maximum, the best critical points of LAD, timing of fibrillation wave and D-D were 45.5mm, 0.113s,0.155mg/L.5. The sensitivity, specificity, positive predictive value and negative predictive value of D-D were higher than those of LAD and fibrillation wave. In LAD, timing of fibrillation wave, D-D, according to meet the diagnostic criteria of two factors, its diagnosis specificity and positive predictive value than single factor, the sensitivity and negative predictive value were lower; while the three factors, the diagnostic specificity and positive predictive value were higher, but the sensitivity and negative predictive value were lower than with two factors.Conclusion1. The LAD and D-D levels are significantly higher in the NVAF thromboembolic events group than those in the non-thromboembolic events group. Amplitude of fibrillation wave, timing of fibrillation wave and f-f interval are significantly shorter than the latter.2. The sensitivity, specificity, positive predictive value and negative predictive value of D-D are higher than those of LAD and fibrillation. In LAD, timing of fibrillation wave and D-D, according to meet the diagnostic criteria of two factors, its diagnosis specificity and positive predictive value are higher than with single factor, the sensitivity and negative predictive value are lower; while the three factors, the diagnostic specificity and positive predictive value are higher, but the sensitivity and negative predictive value are lower than with two factors.3. LAD, fibrillation wave, D-D have certain clinical value in evaluating the risk of thromboembolic events with NVAF, the value of the diagnosis of the different combinations of three factors is higher.
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