Biomarkers for Predicting Left Atrial or Left Atrial Appendage Thrombus in Anticoagulated Patients with Nonvalvular Atrial Fibrillation

Abstract

Purpose. Although atrial fibrillation (AF) is often associated with thromboembolic complications, there is no definite biomarker for detecting the presence of thrombi in the left atrial (LA) or left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation (NVAF). Methods. NVAF patients who underwent transesophageal echocardiography (TEE) to evaluate LA/LAA thrombus and spontaneous echo contrast (SEC) before AF ablation were included. Multivariate logistic regression and receiver operating characteristic curve (ROC) analyses were performed to explore the independent risk factors of LA/LAA thrombus and indicate the best cutoff point. Results. Of the 260 consecutive subjects (mean age: 63.67 ± 9.39 years; 42% women), 45 (17.3%) patients were with LA/LAA thrombus, 131 (50.4%) were with SEC, and 84 (32.3%) were with neither thrombus nor SEC. The results of multivariate logistic regression analysis showed that N-terminal pro-B-type natriuretic peptide (NT-proBNP) (OR, 2.179; 95% CI: 1.191–3.987; p=0.012) and red cell distribution width (RDW) (OR, 2.398; 95% CI: 1.075–5.349; p=0.033) were independently correlated with the presence of LA/LAA thrombus but not D-dimer (OR, 0.999; 95% CI: 0.998–1.000; p=0.210). When all patients were divided into four groups based on the combination between RDW (cutoff value: 12.95%) and NT-proBNP levels (cutoff value: 368.9 ng/L), the rate of LA/LAA thrombus was the highest in the high RDW and NT-proBNP group. Conclusion. In anticoagulation patients with NVAF, elevated NT-proBNP and RDW are related to LA/LAA thrombus. Therefore, these might be considered as useful prognostic markers in the management and treatment of NVAF patients.

The Comparative Effectiveness and Safety of Different Anticoagulation Strategies for Treatment of Left Atrial Appendage Thrombus in the Setting of Chronic Anticoagulation for Atrial Fibrillation or Flutter

“…Trial conducted by Wyrembak et al showed superiority of NOAC vs. VKA (0.24% reported LAA thrombi vs. 1.55%, respectively), whereas Frenkel et al showed that prevalence of LAA thrombus on NOAC and VKA was comparable [ 17 , 18 ]. When it comes to clinical factors, apart from CHA 2 DS 2 -VASc scale, chronic kidney disease was related to the higher prevalence of LAA thrombus in the study of Kaplon-Cieslicka et al, while Zhou et al proved that red cell distribution width and NT-proBNP level would be other risk factors of LAA thrombus formation [ 27 , 28 ].…”

Systemic Immune-Inflammation Index as a Predictor of Left Atrial Thrombosis in Nonvalvular Atrial Fibrillation

“…Another study evaluated the association between LAT and RDW and N-terminal (NT)-prohormone BNP (NT-proBNP) in the blood and reported that higher levels of RDW (cutoff ≥12.95%) and NT-proBNP (cutoff ≥368.9 ng/L) were independent predictors of LAT. 25 A study on patients with NVAF who underwent radiofrequency ablation revealed that the CHADS 2 and CHA 2 DS 2 -VASc scores were associated with LAT. 26 Contrary to the above results, we found no significant correlations between LAT and the CHADS 2 and CHA 2 DS 2 -VASc scores in the present study.…”