Jindong Chen1, Mengmeng Zhou1, Hao Wang1, Zhihuang Zheng2, Wenwen Rong3, Ben He4, Liang Zhao5. 1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. 2. Department of Nephrology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China. 3. Department of Statistics Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. 4. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. heben241@126.com. 5. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China. zhaoliang80112@126.com.
Abstract
OBJECTIVE: Risk factors of left atrial thrombus (LAT) or spontaneous echo contrast (LASEC) in non-valvular atrial fibrillation (NVAF) had been reported. However, information in the subgroup of NVAF patients with low CHA2DS2-VASc scores was limited. Here, we evaluated the risk factors of LAT/LASEC in NVAF patients with low CHA2DS2-VASc scores. METHODS: Transesophageal echocardiography (TEE) file of NVAF patients with low CHA2DS2-VASc scores was reviewed (between June 2009 and Feb 2019) in this retrospective observational study. Binary logistic regression analysis was performed to identify risk factors other than the CHA2DS2-VASc score. Propensity score matching (PSM) was used to further evaluate independent risk markers for LAT/LASEC. The newly discovered factors were added to the CHA2DS2-VASc score, and receiver operating characteristic analysis was used to evaluate the ability of the model to predict LAT/LASEC. RESULTS: TEE files of 3056 NVAF patients with low CHA2DS2-VASc scores were reviewed. Regression analysis revealed elevated fibrinogen and enlarged left atrium (LA) were risk factors for LAT/LASEC. Further PSM analysis confirmed that elevated fibrinogen and enlarged LA were independent risk factors for LAT/LASEC. After including fibrinogen and left atrial diameter (LAD), the CHA2DS2-VASc score was more accurate for LAT/LASEC prediction in NVAF patients with low CHA2DS2-VASc scores (area under the curve difference is 0.241, 95% confidence interval (CI) 0.188-0.294, Z = 8.890, P < 0.0001). CONCLUSIONS: Elevated fibrinogen and enlarged LA were independent risk factors for LAT/LASEC in NVAF patients with low CHA2DS2-VASc scores. Taking fibrinogen and LAD into consideration may help improve LAT/LASEC risk evaluation, which warrants further validation studies.
OBJECTIVE: Risk factors of left atrial thrombus (LAT) or spontaneous echo contrast (LASEC) in non-valvular atrial fibrillation (NVAF) had been reported. However, information in the subgroup of NVAF patients with low CHA2DS2-VASc scores was limited. Here, we evaluated the risk factors of LAT/LASEC in NVAF patients with low CHA2DS2-VASc scores. METHODS: Transesophageal echocardiography (TEE) file of NVAF patients with low CHA2DS2-VASc scores was reviewed (between June 2009 and Feb 2019) in this retrospective observational study. Binary logistic regression analysis was performed to identify risk factors other than the CHA2DS2-VASc score. Propensity score matching (PSM) was used to further evaluate independent risk markers for LAT/LASEC. The newly discovered factors were added to the CHA2DS2-VASc score, and receiver operating characteristic analysis was used to evaluate the ability of the model to predict LAT/LASEC. RESULTS: TEE files of 3056 NVAF patients with low CHA2DS2-VASc scores were reviewed. Regression analysis revealed elevated fibrinogen and enlarged left atrium (LA) were risk factors for LAT/LASEC. Further PSM analysis confirmed that elevated fibrinogen and enlarged LA were independent risk factors for LAT/LASEC. After including fibrinogen and left atrial diameter (LAD), the CHA2DS2-VASc score was more accurate for LAT/LASEC prediction in NVAF patients with low CHA2DS2-VASc scores (area under the curve difference is 0.241, 95% confidence interval (CI) 0.188-0.294, Z = 8.890, P < 0.0001). CONCLUSIONS: Elevated fibrinogen and enlarged LA were independent risk factors for LAT/LASEC in NVAF patients with low CHA2DS2-VASc scores. Taking fibrinogen and LAD into consideration may help improve LAT/LASEC risk evaluation, which warrants further validation studies.
Authors: John Danesh; Sarah Lewington; Simon G Thompson; Gordon D O Lowe; Rory Collins; J B Kostis; A C Wilson; A R Folsom; K Wu; M Benderly; U Goldbourt; J Willeit; S Kiechl; J W G Yarnell; P M Sweetnam; P C Elwood; M Cushman; B M Psaty; R P Tracy; A Tybjaerg-Hansen; F Haverkate; M P M de Maat; F G R Fowkes; A J Lee; F B Smith; V Salomaa; K Harald; R Rasi; E Vahtera; P Jousilahti; J Pekkanen; R D'Agostino; W B Kannel; P W F Wilson; G Tofler; C L Arocha-Piñango; A Rodriguez-Larralde; E Nagy; M Mijares; R Espinosa; E Rodriquez-Roa; E Ryder; M P Diez-Ewald; G Campos; V Fernandez; E Torres; R Marchioli; F Valagussa; A Rosengren; L Wilhelmsen; G Lappas; H Eriksson; P Cremer; D Nagel; J D Curb; B Rodriguez; K Yano; J T Salonen; K Nyyssönen; T-P Tuomainen; B Hedblad; P Lind; H Loewel; W Koenig; T W Meade; J A Cooper; B De Stavola; C Knottenbelt; G J Miller; J A Cooper; K A Bauer; R D Rosenberg; S Sato; A Kitamura; Y Naito; T Palosuo; P Ducimetiere; P Amouyel; D Arveiler; A E Evans; J Ferrieres; I Juhan-Vague; A Bingham; H Schulte; G Assmann; B Cantin; B Lamarche; J-P Després; G R Dagenais; H Tunstall-Pedoe; M Woodward; Y Ben-Shlomo; G Davey Smith; V Palmieri; J L Yeh; A Rudnicka; P Ridker; F Rodeghiero; A Tosetto; J Shepherd; I Ford; M Robertson; E Brunner; M Shipley; E J M Feskens; D Kromhout; A Dickinson; B Ireland; K Juzwishin; S Kaptoge; S Lewington; A Memon; N Sarwar; M Walker; J Wheeler; I White; A Wood Journal: JAMA Date: 2005-10-12 Impact factor: 56.272