Relationship of inflammatory indices with left atrial appendage thrombus or spontaneous echo contrast in patients with atrial fibrillation

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–tolymphocyte ratio(PLR),and lymphocyte-to-monocyte ratio(LMR),were calculated from complete blood analysis.The associations of inflammatory indices 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.

Predictive value of red cell distribution width on left atrial thrombus or left atrial spontaneous echo contrast in patients with non-valvular atrial fibrillation

Objective To evaluate the predictive value of red cell distribution width （RDW） on left atrial thrombus （LAT） or left atrial spontane- ous echo contrast （LASEC） in patients with non-valvular atrial fibrillation （AF）. Methods We reviewed 692 patients who were diagnosed as non-valvular AF and underwent transesophageal echocardiography （TEE） in Guangdong Cardiovascular Institute from April 2014 to December 2015. The baseline clinical characteristics, laboratory test of blood routine, electrocardiograph measurements were analyzed. Results Eighty-four patients were examined with LAT/LASEC under TEE. The mean RDW level was significantly higher in LAT/LASEC patients compared with the non-LAT/LASEC patients （13.59% ± 1.07% ws. 14.34% ± 1.34%; P 〈 0.001）. Receiver-operating characteristic curve analysis was performed and indicated the best RDW cut point was 13.16%. Furthermore, multivariate logistic regression analysis indicated that RDW level 〉 13.16% could be an independent risk factor for LAT/LASEC in patients with AF. Conclusion Elevated RDW level is associated with the presence of LAT/LASEC and could be with moderate predictive value for LAT/LASEC in patients with non-valvular AF.

The effect of transient balloon occlusion of the mitral valve on left atrial appendage blood flow velocity and spontaneous echo contrast: a comparison in sinus rhythm and atrial fibrillation patients

To investigate the relationship between spontaneous echo contrast (SEC) and left atrial appendage (LAA) blood flow velocity using transesophageal echocardiography (TEE) during percutaneous balloon mitral valvotomy (PBMV) in patients with atrial fibrillation and sinus rhythm Methods Thirty five patients (21 in sinus rhythm and 14 in atrial fibrillation ) with rheumatic mitral stenosis underwent PBMV with intraoperative transesophageal echocardiography monitoring We measured LAA blood flow velocities and observed the left atrium for various grades of SEC (from 0=none to 4=severe), before and after each balloon inflation Results Left atrial appendage maximal emptying velocity (LAA MEV) was reduced from 35±14?cm/s to 6±2?cm/s at peak balloon inflation and increased to 40±16?cm/s after balloon deflation Comparison of the values before balloon inflation and after balloon deflation showed that LAA velocities were significantly lower (P<0 001) During balloon inflation, both maximal emptying velocity (MEV) and maximal filling velocity (MFV) were significantly decreased, compared to those before inflation and after balloon deflation (P<0 01) And both MEV and MFV were significantly higher after balloon deflation relative to those before balloon inflation Patients with atrial fibrillation had significantly lower MEV and MFV before and during balloon inflation and after balloon deflation than patients with sinus rhythm At peak balloon inflation, new or increased SEC grades were observed during 54 of 61 (88%) inflations and unchanged during 7 (12%) inflations SEC grades were reduced after 55 balloon deflations (90%), completely disappeared after 18 deflations (30%) and remained unchanged after 6 deflations (10%) At peak balloon inflation,left atrium spontaneous echo contrast (LASEC) grade 4 was observed during 14 of 27 (93%) inflations in the atrial fibrillation patients, significantly higher than in patients with sinus rhythm (8 of 34, 24%; P <0 05) LASEC completely disappeared after 16 of 34 deflations (47%) in the patients with sinus rhythm, significantly higher than in the atrial fibrillation patients (2 of 27 deflations; P <0 01) The mean time to achieve maximal SEC grade (2 5±1 2?s) correlated with the mean time to trough LAA velocities (2 3±1 1?s ) after balloon inflation Both the time to lowest LAA velocity and the time to highest LASEC were significantly longer in the patients with sinus rhythm than in the atrial fibrillation patients (2 6±1 1?s vs 1 7±1 0?s, P<0 05 and 2 8±1 4?s vs 1 9±1 3?s, P<0 05, respectively) Upon deflation, the mean time to lowest SEC grade (2 9±1 8?s) correlated with the mean time to achieve maximal LAA velocities (2 7±1 6?s) Both intervals are significantly shorter in the patients with sinus rhythm than in the atrial fibrillation patients (2 0±1 6?s vs 3 5±1 5?s, P<0 01 and 2 2±1 7?s vs 3 6± 1 6?s, P<0 05) Conclusion Reducing the blood flow velocity in the human left atrium by balloon occlusion of the mitral valve may enhance SEC, whereas restoring blood flow after balloon deflation would cause enhanced echogenic blood to disappear or decrease in both groups of patients Patients with atrial fibrillation demonstrate more severe blood stagnation of the left atrial body and appendage during transient balloon inflation at mitral valve orifice and slower recovery from the stagnation, decreasing to a lesser extent after balloon deflation, when compared to patients with sinus rhythm

Elevated uric acid level： the chicken or the egg？

The article entitled Predictive value of serum uric acid on left atrial spontaneous echo contrast in non-valvular atrialftbrillation patients by Liao, et al. has given important data regarding the association between uric acid level and spontaneous echo contrast in patients with non-valvular atrial fibrillation. This relationship has become an attrac- tive interest and hereafter more comprehensive studies should be conducted. We would like to contribute to the study for some methodological points.