Prediction Of Left Atrial Thrombosis In Patients With Non-valvular Atrial Fibrillation

Objective To investigate left atrial appendage velocity(LAAV),left atrial diameter(LAD),D-dimer and N-terminal pro-Brain natriuretic peptide,and explore its role of left atrial thrombosis(LAT)in patients in non-valvular atrial fibrillation(NVAF).Methods Randomly selected patients with non-valvular persistent atrial fibrillation who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from December 2017 to December 2019,completed the esophageal echocardiography(TEE),and according to the presence or absence of left atrial thrombosis,non-thrombosis group and thrombosis group.Collect general data of the two groups of patients(sex,age,hypertension,diabetes,smoking history,drinking history,etc.)and calculate the CHA2DS2-VASc score.Transesophageal echocardiography measures the left atrial append age velocity,and transthoracic echocardiography measures the patient's cardiac structure and function,the left atrium diameter,left ventricle end diastolic diameter(LVEDD),Left ventricle end systolic volume(LVESV),Left ventricle end diastolic volume(LVEDV)and Left ventricular ejection fraction(LVEF).Elbow vein blood was drawn from the selected patients on an empty stomach the next morning,and D-dimer and nt-pro-BNP and Hcy were measured by enzyme-linked immunoassay.SPSS 20.0 statistical software was used to analyze and process the data.Results(1)Compared with the non-thrombotic group,the thrombotic group has a higher average age(65.05±10.5 vs 63.69±9.9)years,a higher prevalence rate of hyperte nsion(66.2% vs 58.1%),and a higher smoking rate(56.9% vs 42.9%)(p>0.05).There was no statistical difference in sex,diabetes and drinking history between the throm botic group and the non-thrombotic group.The CHA2DS2-VASc score was 3 points(p>0.05).(2)Compared with the non-thrombotic group,the left atrial appendage velocity in the thrombotic group decreased significantly(26.5 9.1 vs 51.7 14.5)cm/s,left atrial diameter increased(47.5 6.5 vs 47.3 5.5)mm,and left ventricular ejection fraction decreased(56.9 9.5 vs 61.6 10.1)%(p<0.05).Single logistic regression analysis showed that left atrial appendage velocity,left atrial diameter,left ventricular ejection fraction were risk factors for left atrial thrombosis.There was no significant difference in left ventricular end diastolic diameter,left ventricular end systolic volume and left ventricular end diastolic volume between thrombotic group and non-thrombotic group(p>0.05).(3)Compared with the non-thrombotic group,the thrombotic group has higher levels of serum D-dimer(1.2 vs 0.34)ug/l and pro-brain natriuretic peptide(1196 vs 502)pg/ml(p<0.05).Homocysteine in thrombus group was slightly higher than in non-thrombus group(17.2 vs 15.6)umol/l(p>0.05).(4)Multivariate logistic regression analysis showed that left atrial appendage velocity(OR=0.83,95%CI: 0.78-10.87,p<0.001)and left atrial diameter(OR=1.09,95% CI: 1.00-1.18,p=0.044)were independent risk factors for left atrial thrombosis.When the left atrial appendage velocity is 25.5cm/s,the sensitivity and specificity for predicting left atrial thrombosis are 98%,45% and the area under ROC curve is 0.939 respectively.The area under ROC curve of left atrial appendage velocity combined with left atrial diameter to predict left atrial thrombosis is 0.945.The area under ROC curve for predicting left atrial thrombosis by combining D-dimer and nt-pro-BNP is 0.948.Conclusion(1)In LAT prediction and evaluation of NVAF patients,transesophageal echocardiography is more effective in measuring left atrial appendage velocity slowdown than traditional measurement of left atrial thrombus index.There are deficiencies in predicting and evaluating LAT by using CHA2DS2-VASc score alone.(2)Left atrial appendage velocity combined with left atrial diameter,serum D-dimer and brain natriuretic peptide precursor improves the prediction ability of LAT in NVAF patients,and increases the sensitivity and effectiveness.