Increased hemoglobin A1c level associates with low left atrial appendage flow velocity in patients of atrial fibrillation

Abstract

Background and aims: High hemoglobin A1c (HbAlc) level is associated with increased cardiovascular disease risk and thromboembolic events [1]. The study sought to explored the association between HbAlc and left atrial appendage flow velocity (LAAV) among non-valvular atrial fibrillation (AF) patients. Methods and results: A total of 249 consecutive non-valvular AF patients who underwent transesophageal echocardiography (TEE) were divided into two subgroups according to the median of LAAV level (<45 cm/s, !45 cm/s). Blood samples and other baseline clinical data of all patients were collected and analyzed. The low LAAV group included 126 patients and the high LAAV group included 123 patients. Patients in the low LAAV group were older and had a higher percentage of persistent AF, chronic heart failure, and higher CHA2DS2-VASc score (P < 0.05). HbAlc level in the low LAAV group was significantly higher than the high LAAV group [6.1 (5.7e6.5)% vs 5.9 (5.6e6.2)%, P Z 0.010]. The low LAAV group had larger left atrial diameter (LAD), left atrial area (LAA), higher left atrial pressure (LAP), and lower left ventricular ejection fraction (LVEF) (P < 0.05). Spearman rank correlation analysis showed that the HbAlc level was negatively correlated with LAAV (r Z À0.211, P Z 0.001). Multivariate analysis indicated that female gender (OR Z 2.233, 95% CI 1.110e4.492, P Z 0.024), persistent AF (OR Z 6.610, 95% CI 3.109e14.052, P < 0.001), and HbAlc (OR Z 1.903, 95% CI 1.092e3.317, P Z 0.023) were independent factors that associated with low LAAV in AF patients. Conclusion: Increased HbAlc level is associated with decreased LAAV and may reflect a low contractile function of the left atrial appendage.

Predicting a decrease in left atrial appendage flow velocity using left atrial diameter and CHA2DS2-VASc score in patients with non-valvular atrial fibrillation

“…We also showed that LAAFV is related to BNP concentration, which is in agreement with previous studies showing that BNP concentration is significantly inversely correlated with LAAFV in patients with AF [ 20 ]. In this study, we found that the persistent AF decreased the risk of decreased LAAFV in multivariate logistics analysis, which was opposite to the results of the linear analysis and previous study [ 27 ]. The paradoxical results were mainly caused by the cutoff value of LAAFV we chose.…”

Nomogram to Predict Left Atrial Appendage Flow Velocity in Atrial Fibrillation

“…Prior studies did not have a uni ed cutoff for low LAA ow velocity, but we all found that non-paroxysmal AF and a larger LAD are linked to an increased rate of reduced LAA ow velocity. [14][15][16] Many previous studies have also found that non-paroxysmal AF and a larger LAD are also associated with left atrial appendage thrombus or ESC formation. We speculate that the reduced LAA ow velocity may play a vital part in this process.…”

“…In addition, LAA ow velocity has been used as surrogates of LA reservoir and contractile function Several studies have identi ed risk factors associated with decreased LAA ow velocity, including AF type, older age, heart failure, hemoglobin A1c, female sex, brain natriuretic peptide, and LA or LAA anatomy. [11][12][13][14][15][16] However, there are currently no available models to predict LAA ow velocity. Therefore, the purpose of this research was to explore clinical, laboratory, and echocardiographic risk factors for reduced LAA ow velocity in patients with AF and to design a nomogram for AF patients.…”