Predictive value of age-adjusted D-dimer combined with high-density lipoprotein cholesterol for left atrial thrombosis in patients with atrial fibrillation

  AIM   To evaluate the predictive value of age-adjusted D dimers (DDage) combined with high-density lipoprotein cholesterol (HDL-C) for left atrial thrombosis (LAT) in patients with atrial fibrillation.

  METHODS   Patients with atrial fibrillation admitted to the First Hospital of Lanzhou University from January 2016 to October 2020 were enrolled. The patients were divided into LAT group and non-LAT group according to the results of transesophageal echocardiography, The HDL-C and D-dimer levels were recorded, and the DDage was calculated based on their age, The differences of DDage and HDL-C between the two groups were compared. All data were subjected to univariate analysis and multivariate logistic regression analysis to establish the risk factors of LAT. The ROC curve was used to analysis the predictive value of DDage combined with HDL-C for LAT.

  RESULTS   The number of patients with DDage (positive) in LAT group (n=23) was 15 (65.2 %) and in non-LAT group (n=267) was 37, with statistically significant difference (P<0.01). The level of HDL-C in LAT group was significantly lower than that in non-LAT group (0.99±0.26 vs. 1.15±0.34, P<0.05). Logistic regression analysis showed that DDage (OR=9.541, 95%CI=3.413-26.667, P<0.01), HDL-C (OR=0.067, 95%CI 0.007-0.636, P<0.05), CHA₂DS₂-VASc≥2 (OR=3.043, 95%CI 1.019-9.090, P<0.05) and LVEF (OR=0.932, 95%CI 0.880-0.987, P<0.05) were all independent risk factors for LAT. The area under the ROC curve showed that the predictive value of DDage combined with HDL-C (AUC=0.842) was better than DDage (AUC=0.757) or HDL-C (AUC=0.674) alone, and the differences were statistically significant (P<0.05).

  CONCLUSION   DDage combined with HDL-C has good predictive value for LAT in patients with atrial fibrillation and they can be used to identify LAT in clinical practice.