Study Of Correlation Between Left Atrial Appendage Structure And Thrombus Formation In Patients With Atrial Fibrillation

Objective:To analyzed the relationship between left atrial appendage structure and thrombus formation in patients with atrial fibrillation.Methods:In this study,283 patients with atrial fibrillation undergoing radiofrequency ablation in Shanxi Bethune Hospital from January 2012 to January 2021,and who met the inclusion criteria and exclusion criteria were selected.The patients were divided into thrombus and non-thrombosis groups based on transesophageal echocardiography results.Among them 40 patients in the thrombus group[mean age(62.1±9.2)years]and 243patients in the non-thrombosis group[mean age(60.1±10.3)years].The differences between the general data,biochemical indexes,left ventricular ejection fraction,left atrial diameter,left atrial appendage length,left atrial appendage volume,left atrial appendage height,left atrial appendage first curvature and left atrial appendage lobes of the two groups were compared.Univariate analysis was performed to find variables with predictive power and then multivariate logistic regression analysis using binary logistic regression to derive independent risk factors for left atrial appendage thrombosis,and the ROC curve was constructed to understand the predictive power of each independent risk factor.Results:(1)There were no difference between thrombus and non-thrombosis group in gender,mean age,height,weight,smoking,alcohol consumption,proportion of combined sleep apnea hypopnea syndrome and coronary heart disease,serum creatinine,blood urea nitrogen,plasma fibrinogen,D-dimer,triglycerides,low-density lipoprotein cholesterol,homocysteine,mean platelet volume and left atrial appendage height(P>0.05).Compared with the non-thrombosis group,the thrombus group’s body mass index,atrial fibrillation duration,persistent atrial fibrillation proportion,CHA2DS2-VASc score,uric acid,brain natriuretic peptide,left atrial diameter,left atrial appendage length,left atrial appendage volume,left atrial appendage first curvature and left atrial appendage lobes were large,and left ventricular ejection fraction was small,with statistically significant difference(P<0.05).(2)Univariate logistic regression analysis:fibrillation duration,persistent atrial fibrillation proportion,CHA2DS2-VASc score,uric acid,brain natriuretic peptide,left ventricular ejection fraction,left atrial diameter,left atrial appendage length,left atrial appendage volume,left atrial appendage first curvature and left atrial appendage lobes were associated with increased the risk of thrombosis(P<0.05).(3)Multivariate logistic regression analysis:CHA2DS2-VASc score,left atrial diameter,left atrial appendage length,left atrial appendage volume,left atrial appendage first curvature and left atrial appendage lobes were independent risk factors for thrombosis in patients with atrial fibrillation(P<0.05).(4)ROC curve:CHA2DS2-VASc score≥4(AUC 0.733,P<0.001),left atrial diameter≥43.6mm(AUC 0.821,P<0.001),left atrial appendage volume≥7.155cm~3(AUC0.839,P<0.001),left atrial appendage length≥25.01mm(AUC 0.883,P<0.001),left atrial appendage first curvature≥121.5°(AUC 0.781,P<0.001)and left atrial appendage lobes≥3(AUC 0.829,P<0.001)were the best predictive values.Conclusion:Left atrial appendage length,volume,first curvature and lobes are good predictors of thrombosis.Pointing out clinically can take left atrial appendage structure as a complement to the CHA2DS2-VASc scores in anticoagulation decision-making for atrial fibrillation patients.