The Clinical Study On Left Atrial Appendage Thrombogenic Milieu In Patients With Non-valvular Atrial Fibrillation

Objective:To analyze the risk factors of left atrial appendage thrombogenic milieu（LAATM）in patients with non-valvular atrial fibrillation（NVAF）,and to explore the relationship between white blood cell count（WBC）,neutrophil count（NEUT）,lymphocyte count（LY）,monocyte count（MO）,neutrophil-to-lymphocyte ratio（NLR）,platelet-to-lymphocyte ratio（PLR）and LAATM formation in patients with NVAF.Methods:The data of 264 patients with NVAF who were hospitalized in Lanzhou University Second Hospital from January 2019 to August 2022 and met the inclusion and exclusion criteria were retrospectively analyzed.All included patients underwent transesophageal echocardiography（TEE）examination and left atrial pulmonary vein CT dual-phase enhanced scanning during hospitalization.The 264 patients with NVAF were divided into LAATM group（n=64）and non-LAATM group（n=200）based on the results of the TEE.Statistical analysis of clinical data of the two groups was performed using SPSS 26.0 software,and comparisons between groups were performed using independent samples t-test,Mann-Whitney U test,and chi-square test,univariate and multivariate logistic regression analyses were used to explore the association between WBC,NEUT,LY,MO,NLR,PLR and LAATM in patients with NVAF,and the receiver operating characteristic（ROC）curve was used to evaluate the predictive value of the relevant indicators for LAATM formation in patients with NVAF.Delong’s test was performed using Med Calc 20.0 software to further compare the difference in the area under the curve（AUC）of the different predictors.Taking TEE as the gold standard,the diagnostic value of left atrial pulmonary vein CT dual-phase enhanced scanning for LAATM was analyzed in patients with NVAF.Kappa test was used to detect the consistency of the two examination methods in the diagnosis of LAATM,and the sensitivity,specificity,negative predictive value,and positive predictive value of left atrial pulmonary vein CT dual-phase enhanced scanning in the diagnosis of LAATM were calculated.Results:A total of 264 patients with NVAF were included in our study,including64 patients（24.2%）in the LAATM group and 200 patients（75.8%）in the non-LAATM group.The results of the univariate analysis demonstrated that there were significant differences between the two groups in age,heart failure,coronary heart disease,stroke history,type of atrial fibrillation,CHA₂DS₂-VASc score,WBC,NEUT,MO,NLR,PLR,RDW-CV,RDW-SD,AST,TBIL,PT,FIB,left atrial diameter,left ventricular end-systolic dimension,left ventricular end-diastolic dimension,left ventricular ejection fraction,the proportion of mitral regurgitation,and proportion of cauliflower left atrial appendage（P＜0.05）.Multivariate logistic regression analysis demonstrated that PLR（OR=1.013,95%CI:1.004–1.023,P=0.007）,CHA₂DS₂-VASc score（OR=1.910,95%CI:1.197–3.049,P=0.007）,persistent/permanent atrial fibrillation（OR=3.580,95%CI:1.056–12.137,P=0.041）,mitral regurgitation（OR=2.969,95%CI:1.066–8.265,P=0.037）,cauliflower left atrial appendage（OR=3.477,95%CI:1.117–10.827,P=0.032）were independent risk factors of LAATM in patients with NVAF.The ROC curve showed that the AUC of PLR,CHA₂DS₂-VASc score,and PLR combined with CHA₂DS₂-VASc score for the prediction of LAATM in NVAF patients was 0.582（95%CI:0.495–0.670,P=0.048）,0.782（95%CI:0.721–0.843,P＜0.001）,0.800（95%CI:0.741–0.858,P＜0.001）,respectively.When the PLR was 181.88,the predictive value for LAATM formation in patients with NVAF was the highest,with a sensitivity of 26.6%and a specificity of 94.0%.The results of Delong’s test suggested that the AUC of CHA₂DS₂-VASc score,PLR combined with CHA₂DS₂-VASc score in predicting the occurrence of LAATM in NVAF patients was significantly higher than that of PLR,which was statistically significant（P＜0.05）,while the AUC of PLR combined with CHA₂DS₂-VASc score had no obvious advantage compared with that of CHA₂DS₂-VASc score alone（P＞0.05）.Taking TEE as the gold standard,the sensitivity,specificity,negative predictive value,and positive predictive value of left atrial pulmonary vein CT dual-phase enhanced scanning for the diagnosis of LAATM were 42.0%,87.0%,82.0%,and 50.0%,respectively.By the Kappa test,the kappa value was 0.303（P＜0.001）and the consistency of the two methods was low.Conclusion:1.PLR,CHA₂DS₂-VASc score,persistent/permanent atrial fibrillation,mitral regurgitation,and cauliflower left atrial appendage are independent risk factors of left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation.2.PLR has certain predictive value for LAATM formation in patients with NVAF.When PLR is 181.88,the predictive value for LAATM formation is the highest,with a sensitivity of 26.6%and a specificity of 94.0%.3.The consistency between left atrial pulmonary vein CT dual-phase enhanced scanning and transesophageal echocardiography in detecting left atrial appendage thrombogenic milieu was low.