The Correlation between Ultrasonographic Morphology and Structure of the Left Atrial Appendage, Blood Flow Velocity, and Plasma Galectin-3 Levels with Thrombus Formation in the Left Atrial Appendage of Patients with Atrial Fibrillation
Correlation of Left Atrial Appendage Factors with Thrombus Formation
Abstract
Background: To explore the correlation between left atrial appendage morphology, blood flow velocity and plasma galectin-3 and thrombosis in patients with atrial fibrillation.
Methods: Patients with atrial fibrillation who received treatment and completed ultrasound examination in hospital from 2022 to December 2023 were enrolled. According to whether there was left atrial appendage thrombosis, the patients were divided into a control group (no left atrial appendage thrombosis was found) and a study group (left atrial appendage thrombosis was found). The morphology and structure of the left atrial appendage, blood flow velocity and plasma galectin-3 level were recorded,exploring its correlation with left atrium thrombosis.
Results: A total of 330 patients with atrial fibrillation were enrolled, including 278 in the control group and 52 in the study group. Left group and the control group of morphological structure differences (P < 0.05). The main lobe length, ostial area, longest diameter, shortest diameter, left atrial appendage volume and left atrial volume in the study group were higher than those in the control group (P < 0.05). The left atrial appendage emptying velocity, filling velocity and left ventricular ejection fraction of the study group were lower than those of the control group, and the left ventricular end-diastolic diameter was higher than that of the control group (P < 0.05). Group of white blood cell count, neutrophils/lymphocyte ratio, plasma galactose lectin - 3 levels were higher than control group (P < 0.05). ROC curve analysis of left atrial appendage emptying velocity, left atrial appendage filling velocity, left atrial end-diastolic diameter and left atrial ejection fraction had higher diagnostic value (P < 0.05).
Conclusion: Left atrial appendage morphology, blood flow velocity and plasma galectin-3 level are important factors to evaluate the risk of left atrial appendage thrombosis in patients with atrial fibrillation, which can be used for clinical diagnosis and decision-making.
References
2. Miyauchi S, Tokuyama T, Uotani Y, Miyamoto S, Ikeuchi Y, Okamura S, et al. Association between left atrial appendage fibrosis and thrombus formation: A histological approach. J Cardiovasc Electr 2022; 33(4): 677-87.
3. Price MJ. Device-Related Thrombus After Transcatheter Left Atrial Appendage Closure. Jacc-Cardiovasc Inte 2019; 12(11): 1015-7.
4. Castellani C, Gao Y, Kim H, Thompson C, Ning J, Lohr N, et al. Left atrial appendage structural characteristics predict thrombus formation. J Cardiovasc Electr 2023; 34(8): 1683-9.
5. Chahine Y, Akoum N. Fibrosis: A nexus between atrial fibrillation and left atrial appendage thrombosis. J Cardiovasc Electr 2022; 33(4): 688-9.
6. Budnik M, Gawalko M, Gorczyca I, Uzieblo-Zyczkowska B, Krzesinski P, Kochanowski J, et al. Risk of left atrial appendage thrombus in patients with atrial fibrillation and chronic kidney disease. Cardiol J 2022; 29(2): 205-15.
7. Negrotto SM, Lugo RM, Metawee M, Kanagasundram AN, Chidsey G, Baker MT, et al. Left atrial appendage morphology predicts the formation of left atrial appendage thrombus. J Cardiovasc Electr 2021; 32(4): 1044-52.
8. Sinning CR. Biomarkers for detection of a thrombus in the left atrial appendage: the search for the grail? Heart 2021; 107(3): 176-7.
9. Safavi-Naeini P, Rasekh A. Thromboembolism in Atrial Fibrillation: Role of the Left Atrial Appendage. Card Electrophysiol Clin 2020; 12(1): 13-20.
10. Abanador-Kamper N, Bepperling J, Seyfarth M, Haage P, Kamper L. Impact of left atrial appendage morphology on thrombus formation in TAVI patients with atrial fibrillation. Eur J Med Res 2023; 28(1): 88.
11. Erickson M, Yadav H, Sneij E, Austin J, Manyam H. Incidence of left atrial appendage thrombus despite 3 weeks of anticoagulation and the need for precardioversion echocardiography. Ann Noninvas Electro 2022; 27(5): e12989.
12. Fang R, Li Y, Zhang Y, Chen Q, Liu Q, Li Z. Impact of left atrial appendage location on risk of thrombus formation in patients with atrial fibrillation. Biomech Model Mechan 2021; 20(4): 1431-43.
13. Lurie A, Wang J, Hinnegan KJ, McIntyre WF, Belley-Cote EP, Amit G, et al. Prevalence of Left Atrial Thrombus in Anticoagulated Patients With Atrial Fibrillation. J Am Coll Cardiol 2021; 77(23): 2875-86.
14. Alkhouli M, Alarouri H, Kramer A, Korsholm K, Collins J, De Backer O, et al. Device-Related Thrombus After Left Atrial Appendage Occlusion: Clinical Impact, Predictors, Classification, and Management. Jacc-Cardiovasc Inte 2023; 16(22): 2695-707.
15. Durmaz E, Karpuz MH, Bilgehan K, Ikitimur B, Ozmen E, Ebren C, et al. Left atrial thrombus in patients with atrial fibrillation and under oral anticoagulant therapy; 3-D transesophageal echocardiographic study. Int J Cardiovas Imag 2020; 36(6): 1097-103.
16. Osawa K, Nakanishi R, Ceponiene I, Nezarat N, French WJ, Budoff MJ. Predicting Left Atrial Appendage Thrombus from Left Atrial Volume and Confirmation by Computed Tomography with Delayed Enhancement. Tex Heart I J 2020; 47(2): 78-85.
17. Melduni R, Nkomo VT, Wysokinski W, Gersh BJ, Deshmukh A, Padang R, et al. Risk of left atrial appendage thrombus and stroke in patients with atrial fibrillation and mitral regurgitation. Heart 2022; 108(1): 29-36.
18. Yilmaz KC, Akgun AN, Ciftci O, Eroglu S, Pirat B, Sade E, et al. Risk factors for left atrial appendage thrombus. Acta Cardiol 2020; 75(4): 355-9.
19. Sahiner L, Coteli C, Kaya EB, Ates A, Kilic GS, Yorgun H, et al. Left Atrial Appendage Occlusion in Patients With Thrombus in Left Atrial Appendage. J Invasive Cardiol 2020; 32(6): 222-7.
20. Saito A, Kato T, Ikoma T, Tsunekawa K, Takama N, Kimura T, et al. Pseudo-thrombus mechanism in left atrial appendage visualized via transthoracic echocardiography. J Med Ultrason 2021; 48(4): 645-7.
Copyright (c) 2024 Linghui Zhao, Min Li, Yuchen Zhang, Wenrui Tang, Dawei Huang, Guanjin Zhou, Bo Zhu, Zhiqi Han, Dingyue Zhu
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