Significance of serum inflammatory markers and their predictive value for occurrence of left atrial appendage thrombosis in patients with atrial fibrillation / 中国中西医结合急救杂志

ABSTRACT

Objective To investigate the clinical significance of the levels of serum C-reactive protein (CRP), peripheral blood ratio of neutrophil to lymphocyte (N/L) and plasma D-dimer in patients with different types of atrial fibrillation (AF) and the predictive value of the above index levels in occurrence of complicated left atrial appendage thrombosis in such patients. Methods A prospective study was conducted, one hundred and forty patients with non-valvular AF admitted to Cangzhou Central Hospital from May 2013 to December 2016 were enrolled, including 57 patients with paroxysmal AF in paroxysmal AF group and 83 patients with persistent AF in persistent AF group; in the mean time, 40 healthy persons having passed physical examination with normal sinus rhythm were volunteers assigned in a healthy control group. 83 patients with persistent AF were followed up for 1 year, and by the esophageal echocardiography, 13 cases with left atrial appendage thrombosis (AF combined with thrombosis group) and 70 cases with non-thrombotic patients (simple AF group) were found. In the morning on the day of entrance into the respective group, fasting venous blood was taken from the patients, and the peripheral blood N/L ratio, serum CRP, plasma D-dimer and B-type natriuretic peptide (BNP) levels were checked; the left atrial diameter (LAD), left atrial ejection fraction (LAEF), left atrial peak strain rate (LASRs) during left ventricular systolic phase, early diastolic peak blood flow velocity of mitral annulus/mitral annulus root side wall velocity peak value (E/Ea) ratio were measured by the trans-thoracic echocardiography, and the differences in above indexes were compared among various groups; the risk factors of persistent AF associated with left atrial appendage thrombosis were analyzed by multivariate Logistic regression; the receiver operation characteristic (ROC) curve was used to analyze the predictive value of D-dimer and BNP levels for persistent AF associated with left atrial appendage thrombosis. Results The peripheral blood N/L ratio (2.68±0.58, 2.59±0.62 vs. 1.82±0.29), CRP (mg/L 19.87±3.28, 20.74±4.31 vs. 8.65±1.06), BNP (ng/L 364.79±54.18, 145.86±51.90 vs. 139.40±48.29), LAD (mm 40.79±3.90, 34.28±2.13 vs. 33.90±2.51), LAEF (0.16±0.07, 0.39±0.08 vs. 0.56±0.10), LASRs (s-1 -1.65±0.23, -1.98±0.32 vs. -3.49±0.53), E/Ea ratio (4.38±0.48, 4.29±0.52 vs. 4.09±0.64) levels in the persistent AF group and the paroxysmal AF group were significantly higher than those of healthy control group, and BNP, LAD, LAEF in persistent AF group were significantly higher than those of the paroxysmal AF group (all P ＜ 0.05). N/L ratio (3.19±0.47 vs. 2.62±0.58), serum CRP (mg/L24.38±5.26 vs. 18.92±3.45), plasma D-dimer (mg/L 2.56±0.41 vs. 1.57±0.39), BNP (ng/L 659.35±78.29 vs. 381.22±69.43) and LAD (mm 42.12±4.28 vs. 36.78±3.42), E/Ea ratio (6.79±0.62 vs. 4.59±0.59) in AF combined with thrombosis group were significantly higher than those in simple AF group (all P ＜ 0.05), and LAEF (0.29±0.05 vs. 0.30±0.06), LASRs (-1.79±0.27 vs. -1.86±0.39) were lower than those in simple AF group, but the differences were of no statistical significance (all P ＞ 0.05). Multivariate Logistic regression analysis showed plasma D-dimer [odds ratio (OR) = 2.458, 95% confidence interval (95%CI) = 1.764 - 3.016, P = 0.035], BNP (OR = 2.631, 95%CI =1.589 - 3.127, P = 0.021), LAD (OR = 5.572, 95%CI = 4.031 - 6.452, P = 0.001) and E/Ea ratio (OR = 1.995, 95%CI =1.674 - 3.851, P = 0.003) were the independent risk factors for persistent AF combined with left atrial appendage thrombosis. The ROC curve showed when plasma D-dimer and BNP levels could predict the patients with persistent AF complicated with left atrial appendage thrombosis, the area under the ROC curve (AUC) was 0.872 and 0.741, respectively, and when the plasma D-dimer was 1.45 mg/L and BNP was 569.33 ng/L respectively, the sensitivity of diagnosis for the above patients was 67.81%, 62.25%, and the specificity was 75.90% and 57.62% respectively. Conclusions The levels of serum inflammatory markers, plasma biological markers and left atrial function were different in patients with different types of AF. The left atrial enlargement, left ventricular diastolic dysfunction, elevation of plasma D-dimer and plasma BNP levels are the independent risk factors for patients with persistent AF complicated with left atrial appendage thrombosis. When diastolic dysfunction occurs in the left ventricle, the elevated levels of plasma D-dimer and natriuretic peptide have predictive value for left atrial appendage thrombosis.