Wang Z, Wang BH, Yang XL, Xia YL, Zhang SM, Che Y. Relationship of inflammatory indices with left atrial appendage thrombus or spontaneous echo contrast in patients with atrial fibrillation. World J Clin Cases 2024; 12(21): 4550-4557 [PMID: 39070837 DOI: 10.12998/wjcc.v12.i21.4550]
Corresponding Author of This Article
Ying Che, MD, Professor, Department of Ultrasonography, First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116000, Liaoning Province, China. cheying@dmu.edu.cn
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Retrospective Study
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Wang Z, Wang BH, Yang XL, Xia YL, Zhang SM, Che Y. Relationship of inflammatory indices with left atrial appendage thrombus or spontaneous echo contrast in patients with atrial fibrillation. World J Clin Cases 2024; 12(21): 4550-4557 [PMID: 39070837 DOI: 10.12998/wjcc.v12.i21.4550]
Zhao Wang, Ying Che, Department of Ultrasonography, First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
Bin-Hao Wang, Arrhythmia Center, First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
Xiao-Lei Yang, Yun-Long Xia, Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
Sheng-Min Zhang, Department of Ultrasonography, First Affiliated Hospital of Ningbo University, Ningbo 315000, Zhejiang Province, China
Co-corresponding authors: Sheng-Min Zhang and Ying Che.
Author contributions: Wang Z, Wang BH, Zhang SM, and Che Y conceived, designed, and refined the study protocol; Wang Z and Wang BH were involved in the data collection; Wang Z, Wang BH, Zhang SM, and Che Y analyzed the data; Wang Z and Wang BH drafted the manuscript; all authors have read and approved the final manuscript. Zhang SM and Che Y were designated as co-corresponding authors for two reasons. First, the study was performed as a collaborative effort, and the designation of co-corresponding authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the investigation and the resultant paper. Second, Zhang SM and Che Y contributed efforts of equal substance throughout the research process. The choice of these researchers as co-corresponding authors acknowledges and respects this equal contribution. Therefore, we believe that designating Zhang SM and Che Y as co-corresponding authors is suitable for our manuscript as it accurately reflects our team's collaborative spirit and equal contributions.
Supported byPublic Welfare Technology Project of Ningbo Science and Technology Bureau, No. 2023S140; and Medical Health Science and Technology Project of Zhejiang Province Health Commission, No. 2024KY1518.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Ningbo University.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Corresponding author: Ying Che, MD, Professor, Department of Ultrasonography, First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116000, Liaoning Province, China. cheying@dmu.edu.cn
Received: March 17, 2024 Revised: May 13, 2024 Accepted: May 28, 2024 Published online: July 26, 2024 Processing time: 106 Days and 0.4 Hours
Abstract
BACKGROUND
Inflammatory indices derived from complete blood tests have been reported to be associated with poor outcomes in patients with atrial fibrillation (AF). The data about the relationship between inflammatory indices and left atrial appendage thrombus (LAAT) or dense spontaneous echo contrast (SEC) are limited.
AIM
To explore the value of inflammatory indices for predicting the presence of LAAT or dense SEC in nonvalvular AF patients.
METHODS
A total of 406 patients with nonvalvular AF who underwent transesophageal echocardiography were included and divided into two groups based on the presence (study group) or absence (control group) of LAAT or dense SEC. Inflammatory indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet–to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), were calculated from complete blood analysis. The associations of inflammatory indices with LAAT/dense SEC were analyzed using logistic regression.
RESULTS
LAAT and dense SEC were detected in 11 (2.7%) and 42 (10.3%) patients, respectively. The PLR only showed an association with LAAT/dense SEC in the univariate model. Elevated NLR (odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.11-1.98, P = 0.007) and reduced LMR (OR = 0.59, 95%CI: 0.41-0.83, P = 0.003) were found to be independent risk factors for the presence of LAAT/dense SEC. The areas under the NLR and LMR curves for predicting LAAT/dense SEC were 0.73 (95%CI: 0.66-0.80, P < 0.001) and 0.73 (95%CI: 0.65-0.81, P < 0.001), respectively, while the cutoff values were 2.8 (sensitivity: 69.8%; specificity: 64.0%) and 2.4 (sensitivity: 71.7%; specificity: 60.6%), respectively.
CONCLUSION
Increased NLR and decreased LMR may predict LAAT/dense SEC in patients with nonvalvular AF.
Core Tip: Atrial fibrillation (AF) increases the risk of ischemic stroke. One of the most powerful risk factors for ischemic stroke is the development of a thrombus and spontaneous echo contrast (SEC) in the left atrial appendage (LAA). Inflammatory state increases the propensity for thrombosis in AF patients. Therefore, we explored the value of inflammatory indices for predicting the presence of LAA thrombus or dense SEC. The results showed that some inflammatory indices derived from complete blood tests, including the neutrophil-lymphocyte ratio and lymphocyte-monocyte ratio, may predict LAA thrombus or dense SEC in patients with nonvalvular AF.
