In Paroxysmal Atrial Fibrillation Patients, the Neutrophil-to-lymphocyte Ratio Is Related to Thrombogenesis and More Closely Associated with Left Atrial Appendage Contraction than with the Left Atrial Body Function

Abstract

Objective The neutrophil-to-lymphocyte ratio (NLR) is an inflammation marker that can be used to detect atrial inflammatory changes, which may contribute to a reduced left atrial (LA) function and thrombosis. Our study aimed to determine whether or not the association of NLR with the LA appendage (LAA) function in relation to thrombogenesis differs from the association with the LA body function in paroxysmal atrial fibrillation (PAF) patients. Methods A total of 183 PAF patients were studied. The LA volume index, mitral flow velocity (A), and mitral annular motion velocity (A′) were examined using transthoracic echocardiography. The LAA area, LAA wall motion velocity, and presence of spontaneous echo contrast (SEC) were examined using transesophageal echocardiography. Results The NLR of patients with cerebral embolism was significantly greater than in patients without the disorder. A cut-off point of 2.5 for the NLR had a sensitivity of 71% and a specificity of 74% in predicting cerebral embolism. The patients with an NLR ≥2.5 had a higher CHADS2 score and greater LA volume index or LAA area than those with an NLR <2.5. The NLR was an independent risk factor for SEC and was significantly correlated with the LAA wall motion velocity (r=-0.409) in 153 patients without SEC and with the LAA wall motion velocity and LAA area (r=-0.583, r=0.654, respectively) in 30 patients with SEC, but not with the LA volume index, A, or A′ in either group. Conclusion In PAF patients, a high NLR indicates thrombogenesis with a high degree of certainty and is associated with reduced LAA contraction rather than with the LA body function.

Association of inflammation indices with left atrial thrombus in patients with valvular atrial fibrillation

“…Yalcin et al [ 13 ] found a similar significant association in a larger sample, and reported that a higher NLR was an independent risk factor for LAT in 309 patients with NVAF (OR 1.59). Fukuda et al [ 14 ] demonstrated that an elevated NLR was an independent risk factor for spontaneous echo contrast in TEE (OR 1.86) and had greater left atrial volume index, left atrial appendage area and left atrial appendage wall motion velocity during atrial contraction. This study revealed an association between NLR and the left atrial appendage function in relation to thrombogenesis.…”

Predictive value of nutritional indices for left atrial thrombus in patients with valvular atrial fibrillation

“…More prospective studies with larger samples are needed to further validate our findings. Secondly, besides LAD, other echocardiographic paramters for thromboembolic risk in AF patients, such as left atrial volume index, left atrial appendage area and left atrial appendage wall motion velocity, were not routinely measured in our center [ 31 ]. In addition, in the anticoagulated patients enrolled in our study, we did not have information about the quality of anticoagulant control (e.g.time in therapeutic range for patients receiving warfarin and actual intake of oral anticoagulants), which impact the risk of LAT.…”

Applying Machine Learning with Tree Ensemble Methods and SHAP Values based on Routine Circulating Biomarkers to Detect Left Atrial Morphological and Functional Remodeling in Hypertension

“…Transthoracic echocardiography was performed for all participating patient with a Vivid E9 ultrasound system (GE Vingmed Ultrasound, Horten, Norway) equipped with an M5S phased array transducer (2.5-5.0 MHz), and all measurements followed the guideline of the American Society of Echocardiography (21). (Supplementary material provides measurement methods for more relevant indicators).…”