| Objective:The purpose of this study is to explore the related factors of the thrombus of the left atrial(LA)or left atrial appendage(LAA)in non-valvular atrial fibrillation patients(NVAF)without heart failure,to identify predictors of LA/LAA thrombus in NVAF,so as to guide anticoagulation therapy in NVAF,and reduce the morbidity,mortality and readmission rate of thrombo embolic events.Methods:This study selected patients with NVAF who performed transesophageal echocardiography(TEE)in our hospital between December 31,2012 and December31,2017.Finally 200 cases who met the inclusion criteria were enrolled,and according to TEE results,these patients were divided into 3 groups: control group(without thrombus and spontaneous echo contrast(SEC)),SEC group and thrombus group.The clinical characteristics and related examination datas during hospitalization were collected and recorded.The datas were compared between the 3groups.Multivariate logistic regression analysis was used to explore the independent risk factors of LA/LAA thrombosis.Results: In this study 200 patients were enrolled,including male 122 cases,female 78 cases,with an average age 63.60±9.39 years,106 cases(53%)with paroxysmal AF,94 cases(47%)with non paroxysmal AF.Based on TEE,patients were divided into 3 groups,including 64 cases in control group,97 cases in SEC group and 37 cases in thrombus group.1.Comparison of clinical basic characteristics in three groups of patients The proportion of non paroxysmal AF in SEC group and thrombus group was higher than that in control group(P<0.001),and there was no significant difference between SEC group and thrombus group(P>0.0167).The proportion of patients with anticoagulant drugs in the SEC group and the thrombus group was higher than that in the control group,SEC group was higher than control group P<0.0167).There was no significant difference at the other dates between the three groups(P > 0.05).2.Comparison of biochemical indicators between the three groups?The comparison of D-dimer between the three groups,there was no significant difference(P > 0.05).We further analyzed the patients who did not take anticoagulant drugs,the result showed that D-dimer in the thrombus group was higher than that in the control group and the SEC group,but there was no significant difference.?Compared with control group and SEC group,the level of NT-proBNP of the thrombus group was significantly increased(P < 0.01);compared between the control group and the SEC group,the difference was not statistically significant(P > 0.05).? Compared with the control group,the RDW level increased in SEC group and thrombus group(P < 0.05).Compared RBC between the three groups,difference was statistically significant.,but there was no significant difference in platelet count and platelet distribution width between the three groups.3.Compared left ventricular end diastolic diameter,left atrial diameter,right ventricular end diastolic diameter and LVEF between the three groups,the differences were statistically significant;especially the left atrial diameter of the thrombus group was significantly higher than that of SEC group and control group(P<0.001).4.NT-proBNP and RDW have good predictive value for LA/LAA thrombus in patients with non-valvular atrial fibrillation.The ROC area under curve for NT-proBNP to predict LA/LAA thrombus was 0.740(95%CI:0.631 ~ 0.850,P <0.001).The area under the RDWCV curve was 0.664(95%CI:0.532-0.796,P=0.014).The ROC area under curve for D-dimer was 0.447(P > 0.05).5.Multivariate logistic regression analysis showed that NT-proBNP,RBC and RDW were independent risk factors for LA/LAA thrombosis.OR values were 1.001,3.142 and 2.528,respectively,and P values were all less than 0.05.Conclusion: NT-proBNP,red blood cell count and RDW have powerful predictive value for LA/LAA thrombus,could be independent predictors of LA/LAA thrombus in NVAF patients without heart failure,but there is no significant correlation between the D-dimer and LA/LAA thrombus. |
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