Correlation Between Triglyceride Glucose Index And Left Atrial Appendage Flow Velocity In Patients With Non-Valvular Atrial Fibrillation

Objective: To investigate the correlation between the new insulin resistance replacement index triglyceride-glucose product index(TyG)and the left atrial appendage blood flow velocity(LAAFV)in patients with nonvalvular atrial fibrillation and its value in predicting left atrial appendage thrombosis(LAAT),and to analyze other risk factors of left atrial appendage blood flow velocity and thrombosis.Methods: In this study,patients with nonvalvular atrial fibrillation who completed transesophageal echocardiography were collected from January 2021 to January 2023 in the Department of Cardiovascular Medicine,the First Hospital of Lanzhou University.A total of 274 patients were selected according to the inclusion and exclusion criteria.According to the thrombus formation of the left atrial appendage,the patients were divided into LAAT group(n=16)and non-LAAT group(n=258),and the patients were divided into low LAAFV group(n=130,LAAFV<0.41m/s)and high LAAFV group(n=144,LAAFV≥0.41 m/s)according to the median level of LAAFV.The differences in clinical data between the two groups were compared under different conditions.Patients were divided into three groups according to the TyG index quantile method: There were 91 patients in group Q1(TyG≤8.684),92 patients in group Q2(8.685<TyG<9.184),and 91 patients in group Q3(TyG≥9.185).The characteristics of baseline data among all groups were compared,and the differences of clinical features,incidence of LAAT and LAAFV among different TyG index groups were analyzed.The correlation between LAAFV and other clinical indicators was analyzed by Spearman correlation analysis,and whether TyG index was an independent risk factor for LAAT formation in NVAF patients was analyzed by binary Logistic regression.According to CHA2DS2-VASC score,patients were divided into high-risk stroke group(n=126,male>1,female>2)and non-high-risk stroke group(n=148,male≤1,female≤2).According to the median LAAFV level,patients were further divided into low LAAFV group and high LAAFV group,and the differences and characteristics of clinical data between different subgroups were analyzed.Finally,the correlation between TyG index and LAAFV was discussed,receiver operating characteristic curve(ROC)was drawn,area under the curve(AUC)was calculated,and the predictive value of TyG index on LAAT formation was evaluated.Results:1.The incidence of LAAT in this study was about 5.8%.Compared with the nonLAAT group,the number of smoking patients in the LAAT group was significantly higher(P=0.032),and the HbA1C,LYM%,Glu,TyG index,LDH,FIB,D-dimer and FDP were higher(P < 0.05).LAD,left atrial long diameter and left atrial transverse diameter were larger(P < 0.05);ALB,APOAI and LAAFV were lower(P < 0.05),and LVEF was smaller(P < 0.05).Binary logistic regression analysis of risk factors for thrombosis showed that high TyG index,HbA1C,LDH,LYM%,LAD,left atrial length diameter and left atrial transverse diameter were independent risk factors for LAAT formation in NVAF patients,while high APOAI was independent protective factor for LAAT formation(P < 0.05).2.Compared with the low LAAFV group,the patients in the high LAAFV group had fewer TEE clouds of blood flow(P=0.000),a lower incidence of thrombosis(P=0.000),and a lower CHA2DS2-VASC score(P=0.021).HbA1C,LYM%,AST,TBIL,ALB,UA,TG,TyG index,LDH,PT,INR and APTT were lower(P < 0.05),LVEF was higher(P=0.000),and LAD,left atrial long diameter and left atrial transverse diameter(P < 0.05)were smaller.PLT and PTA(P < 0.05)were higher.3.Correlation analysis showed that LAAFV was positively correlated with PLT,NEUT%,PCT,PTA and LVEF.It was negatively correlated with TyG index,GLB,diastolic blood pressure,CHA2DS2-VASC score,HbA1C,LYM%,AST,Urea,UA,Glu,TG,LDH,PT,PTR,INR,APTT,LAD,left atrial long diameter and left atrial transverse diameter.4.According to the grouping of TyG index,it was found that with the increase of TyG index,the incidence of blood flow cloud shadow of the left atrial appendage in the study population gradually increased from Q1 to Q3(P=0.032),and LAAFV gradually decreased from Q1 to Q3 with the TyG index(P=0.001).The LAAFV of Q3 group was significantly lower than that of Q1 and Q2 groups(P < 0.05).5.In the non-high-risk stroke group,compared with the low-LAAFV group,there was a higher proportion of male patients in the high-LAAFV group(P=0.004),and a lower incidence of blood flow shadow(P=0.000)and LAAT(P=0.029).AST,GLB,UA,Glu,TG,TyG index,LDH,PT,INR and D-dimer were also lower(P < 0.05),but PTA(P=0.012)was higher,QRS duration(P=0.015)was longer,LVEF(P=0.000)was higher.LAD,LVDd,LVDs,left atrial long diameter and left atrial transverse diameter were significantly lower than those in low LAAFV group(P < 0.05).In high-risk stroke group,compared with low LAAFV group,patients in high LAAFV group had lower blood flow cloud shadow(P=0.000)and incidence of thrombosis(P=0.003),lower diastolic blood pressure(P=0.004),lower HbA1C,LDH,LYM%,PT,INR and APTT(P < 0.05).However,PTA(P=0.012)and LVEF(P=0.000)were higher,and LAD,left atrial long diameter and left atrial transverse diameter were significantly lower than those in low LAAFV group(P < 0.05).6.ROC curve showed that the area under the curve predicted by TyG index for LAAT formation in NVAF patients was 0.680(95%CI: 5583-0.777,P=0.016).After grouping by CHA2DS2-VASC score,the TyG index predicted the area under the curve of LAAT formation in non-high-risk stroke patients was 0.744(95%CI: 0.641-0.846,P=0.021),had no statistical significance in predicting LAAT formation in high-risk stroke patients(P > 0.05).Conclusions: TyG index is negatively correlated with LAAFV in NVAF patients.For NVAF patients,especially non-high-risk stroke NVAF patients,TyG index has a certain predictive value for LAAT formation.In addition,higher TyG index,HbA1C,LAD,left atrial long diameter and left atrial transverse diameter were independent risk factors for LAAT formation in patients with NVAF.