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 in...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.展开更多
Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thr...Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thrombus remains unclear.In this study,we sought to investigate the effect of MS on risk stratification of LA/LAA thrombus formation in patients with nonvalvular atrial fibrillation （NVAF）.Methods：This cross-sectional study enrolled 294 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapies.LA/LAA thrombus was determined by transesophageal echocardiography.Risk assessment of LA/LAA thrombus was performed using the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores.Logistic regression analyses were performed to determine which factors were significantly related to LA/LAA thrombus.Odds ratio （OR） including 95% confidence interval was also calculated.The predictive powers of different scores for the risk of LA/LAA thrombus were represented by C-statistics and compared by receiver operating characteristic （ROC） analysis.Results：LA/LAA thrombi were identified in 56 patients （19.0%）.Logistic analysis showed that MS was the strongest risk factor for LA/LAA thrombus in NVAF patients （OR =14.698,P 〈 0.001）.ROC curve analyses revealed that the C-statistics of CHADS2-MS and CHA2DS2-VASc-MS was significantly higher than those of CHADS2 and CHA2DS2-VASc scores （CHADS2-MS vs.CHADS2,0.807 vs.0.726,P=0.0019）.Furthermore,MS was helpful for identifying individuals with a high risk of LA/LAA thrombus in the population with a low risk of stroke （CHADS2 or CHA2DS2-VASc score =0）.Conclusions：MS is associated with LA/LAA thrombus risk in patients with NVAF.In addition to the CHADS2 and CHA2DS2-VASc scores,the CHADS2-MS and CHA2DS2-VASc-MS scores provide additional information on stroke risk assessment.展开更多
Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an ass...Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF （NVAF）. The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods： From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate （eGFR） was calculated from baseline and fbllow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a 〉25% decline in eGFR （hereafter, endpoint）~ while Cox models estimated hazard ratios （HRs） and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a -〉25% decline in eGFR. Results： After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin （n = 655） and no anticoagulation groups （n = 296） and 120 （12.6%） patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups （χ2 = 0.178, log-rank P = 0.67）, but patients with systolic blood pressure （SBP） 〈140 mmHg have significant difference with patients with SBP ≥140 mmHg （χ2 = 4.903, log-rank P = 0.03）. Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion： In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.展开更多
目的系统评价新型口服抗凝药(NOACs)用于非瓣膜性房颤患者左心耳封堵(LAAO)术后抗栓的有效性和安全性。方法计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方数据,收集NOACs(试验组)对比华法林或双联抗血小板...目的系统评价新型口服抗凝药(NOACs)用于非瓣膜性房颤患者左心耳封堵(LAAO)术后抗栓的有效性和安全性。方法计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方数据,收集NOACs(试验组)对比华法林或双联抗血小板药(对照组)的随机对照试验(RCT)和队列研究,检索时限为建库至2022年11月。筛选文献、提取数据、评价质量后,采用RevMan 5.4软件进行Meta分析。结果纳入10项研究,包括2项RCT、8项队列研究,共计2653例患者。RCT结果显示,两组患者的器械相关性血栓(DRT)发生率、卒中/全身性栓塞(SSE)发生率、大出血事件发生率、总出血事件发生率、全因死亡率比较,差异均无统计学意义(P>0.05)。队列研究结果显示,与双联抗血小板药比较,试验组患者的DRT发生率、卒中/SSE发生率、大出血事件发生率、全因死亡率差异均无统计学意义(P>0.05);与华法林比较,试验组患者的DRT发生率[RR=0.40,95%CI(0.19,0.82),P=0.01]、总出血事件发生率[RR=0.28,95%CI(0.18,0.44),P<0.00001]均显著降低,而卒中/SSE发生率、大出血事件发生率、全因死亡率差异均无统计学意义(P>0.05)。结论NOACs用于非瓣膜性房颤患者LAAO术后的疗效和安全性与双联抗血小板药相当,DRT发生率和总出血事件发生率低于华法林。展开更多
基金Public Welfare Technology Project of Ningbo Science and Technology Bureau,No.2023S140Medical Health Science and Technology Project of Zhejiang Province Health Commission,No.2024KY1518.
文摘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.
基金This study was supported by the National Natural Science Foundation project （No.81670364） and Natural Science Foundation of Guangdong Province （No. 2016A030313356）.
文摘Background：Metabolic syndrome （MS） is a risk factor for stroke and thromboembolism event.Left atrial or LA appendage （LA/LAA） thrombus is a surrogate of potential stroke.The relationship between MS and atrial thrombus remains unclear.In this study,we sought to investigate the effect of MS on risk stratification of LA/LAA thrombus formation in patients with nonvalvular atrial fibrillation （NVAF）.Methods：This cross-sectional study enrolled 294 consecutive NVAF patients without prior anticoagulant and lipid-lowering therapies.LA/LAA thrombus was determined by transesophageal echocardiography.Risk assessment of LA/LAA thrombus was performed using the CHADS2,CHA2DS2-VASc,MS,CHADS2-MS,and CHA2DS2-VASc-MS scores.Logistic regression analyses were performed to determine which factors were significantly related to LA/LAA thrombus.Odds ratio （OR） including 95% confidence interval was also calculated.The predictive powers of different scores for the risk of LA/LAA thrombus were represented by C-statistics and compared by receiver operating characteristic （ROC） analysis.Results：LA/LAA thrombi were identified in 56 patients （19.0%）.Logistic analysis showed that MS was the strongest risk factor for LA/LAA thrombus in NVAF patients （OR =14.698,P 〈 0.001）.ROC curve analyses revealed that the C-statistics of CHADS2-MS and CHA2DS2-VASc-MS was significantly higher than those of CHADS2 and CHA2DS2-VASc scores （CHADS2-MS vs.CHADS2,0.807 vs.0.726,P=0.0019）.Furthermore,MS was helpful for identifying individuals with a high risk of LA/LAA thrombus in the population with a low risk of stroke （CHADS2 or CHA2DS2-VASc score =0）.Conclusions：MS is associated with LA/LAA thrombus risk in patients with NVAF.In addition to the CHADS2 and CHA2DS2-VASc scores,the CHADS2-MS and CHA2DS2-VASc-MS scores provide additional information on stroke risk assessment.
文摘Background： Warfarin is the most common oral anticoagulant to decrease the stroke risk associated with atrial fibrillation （AF）. There are very few prospective studies that have explored whether warfarin has an association with damage on renal function in Chinese patients with nonvalvular AF （NVAF）. The aim of this study was to evaluate the effects of warfarin on renal function and study the factors associated with kidney dysfunction in Chinese adult NVAF patients without dialysis therapy. Methods： From January 2011 to December 2013, a total of 951 NVAF patients from 18 hospitals were enrolled. The estimated glomerular filtration rate （eGFR） was calculated from baseline and fbllow-up serum creatinine levels. Kaplan-Meier survival curves compared the survival of a 〉25% decline in eGFR （hereafter, endpoint）~ while Cox models estimated hazard ratios （HRs） and 95% confidence intervals for this event after adjustment for age, gender, and selected potential risk factors for renal dysfunction. Cox regression analysis of the various clinical potential variables was performed to identify the predictors of a -〉25% decline in eGFR. Results： After a 58-month follow-up, 951 NVAF patients were divided by observation into warfarin （n = 655） and no anticoagulation groups （n = 296） and 120 （12.6%） patients experienced renal endpoint. Kaplan-Meier survival curves showed that the survival period was not different in the two groups （χ2 = 0.178, log-rank P = 0.67）, but patients with systolic blood pressure （SBP） 〈140 mmHg have significant difference with patients with SBP ≥140 mmHg （χ2 = 4.903, log-rank P = 0.03）. Multivariate Cox regression analysis revealed baseline eGFR and SBP as independent predictors of the endpoint, with HRs of 1.00, and 1.02, respectively. Conclusion： In patients with NVAF, eGFR and SBP are associated with the deterioration of kidney function while Warfarin is not the risk factor of the ≥25% decline in eGFR.
文摘目的系统评价新型口服抗凝药(NOACs)用于非瓣膜性房颤患者左心耳封堵(LAAO)术后抗栓的有效性和安全性。方法计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、中国知网、万方数据,收集NOACs(试验组)对比华法林或双联抗血小板药(对照组)的随机对照试验(RCT)和队列研究,检索时限为建库至2022年11月。筛选文献、提取数据、评价质量后,采用RevMan 5.4软件进行Meta分析。结果纳入10项研究,包括2项RCT、8项队列研究,共计2653例患者。RCT结果显示,两组患者的器械相关性血栓(DRT)发生率、卒中/全身性栓塞(SSE)发生率、大出血事件发生率、总出血事件发生率、全因死亡率比较,差异均无统计学意义(P>0.05)。队列研究结果显示,与双联抗血小板药比较,试验组患者的DRT发生率、卒中/SSE发生率、大出血事件发生率、全因死亡率差异均无统计学意义(P>0.05);与华法林比较,试验组患者的DRT发生率[RR=0.40,95%CI(0.19,0.82),P=0.01]、总出血事件发生率[RR=0.28,95%CI(0.18,0.44),P<0.00001]均显著降低,而卒中/SSE发生率、大出血事件发生率、全因死亡率差异均无统计学意义(P>0.05)。结论NOACs用于非瓣膜性房颤患者LAAO术后的疗效和安全性与双联抗血小板药相当,DRT发生率和总出血事件发生率低于华法林。
