The value of left atrial structural and functional parameters combined with cardiac biomarkers in predicting left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation

Abstract

Objective \nTo investigate the relationships between the structure, function of left atrial as well as cardiac biomarkers and left atrial spontaneous echo contrast (SEC) in patients with non-valvular atrial fibrillation (NVAF), and evaluate its predictive value for left atrial SEC. \n \n \nMethods \nThirty-four control subjects and 80 patients with NVAF were included, patients with NVAF were divided into positive group (30 cases) and negative group (50 cases) according to whether SEC was presented on transesophageal echocardiography (TEE). Clinical and laboratory data were collected, including medical history, cardiac troponin I (cTnI), and pro-brain natriuretic peptide (pro-BNP), etc. Then CHA2DS2-VASc scores were calculated.The left atrial appendage width (WLAA), left atrial appendage depth (DLAA), left atrial appendage blood flow velocity (VLAA), left atrial volume index (LAVI) and other parameters were measured by TEE and transthoracic echocardiography (TTE), and left atrial ejection fraction (LAEF) was calculated. The clinical and TEE parameters were compared between the positive and negative group, TTE parameters and cardiac biomarkers levels were compared among the three groups, and ROC curve was used to evaluate the diagnostic efficiency. \n \n \nResults \n①Compared with those in control group, the value of LAVI and pro-BNP were significantly increased and LAEF was significantly decreased in negative group (all P 0.05), but presented a significant increase in positive group compared with those in control group and negative group (all P<0.01). The AUC, sensitivity and specificity of CHA2DS2-VASc scores for SEC were 0.71 (95% CI: 0.60~0.82), 73.3% and 62.0%, respectively. When left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP), the AUC, sensitivity and specificity for SEC were 0.90 (95%CI: 0.84~0.97), 74.0% and 100%, respectively, both enhanced when compared with CHA2DS2-VASc scores alone(P<0.01). \n \n \nConclusions \nLeft atrial enlargement, decreased function and elevated levels of cardiac biomarkers are associated with left atrial SEC in patients with NVAF.CHA2DS2-VASc scores can be used for perdicting left atrial SEC, left atrial structural and functional parameters (LAVI and LAEF) combined with cardiac biomarkers (cTnI and pro-BNP) provide significant increments in prediction of left atrial SEC. \n \n \nKey words: \nEchocardiography, transesophageal;\xa0Atrial fibrillation;\xa0Atrial function, left;\xa0Spontaneous echo contrast;\xa0Cardiac biomarker