Association of spontaneous echo contrast with Systemic Immune Inflammation Index in patients with mitral stenosis

Evaluation of the effectiveness of C-reactive protein/albumin ratio on thrombus in patients undergoing transesophageal echo

BACKGROUND

Left atrial appendage thrombus (LAAT) is the predominant etiology of ischemic stroke in patients with atrial fibrillation (AF), and LAAT is optimally demonstrated by transesophageal echocardiography (TEE). The study aimed to assess patients with nonvalvular atrial fibrillation (NVAF) identified with thrombus using TEE compared to those without thrombus, utilizing the C-reactive protein/albumin ratio (CAR) as a sensitive biomarker.

METHODS

This study was conducted retrospectively at a single center with 668 patients with NVAF who underwent TEE. Patients were divided into two groups based on the presence or absence of LAAT on TEE. The levels of CAR, C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were compared.

RESULTS

CAR was identified as an independent variable in patients with thrombus detected on TEE. (OR: 12.773, CI: 6.669-24.464, p < 0.001) Albumin was shown to have the highest area under the curve (AUC) value for thrombus prediction, followed by CAR, CRP, NLR, and PLR, in that order. (AUC: 0.999 CI: 0.993-1.000; 0.977 (0.962-0.987); 0.931 (0.909-0.949); 0.600 (0.562-0.937) p < 0.001, AUC: 0.574 CI: 0.535-0.612 p: 0.014).

CONCLUSION

Our study demonstrates that CAR serves as an independent predictor of LAAT and shows more dependability than other biomarkers such as NLR, CRP, and PLR.

Plasma metabolomic characteristics of atrial fibrillation patients with spontaneous echo contrast

BACKGROUND

The spontaneous echo contrast (SEC) in patients with atrial fibrillation (AF) indicates a prethrombic state that ultimately progresses into thrombus formation. A comprehensive understanding of specific plasma metabolomics characteristics may protect AF patients from thrombus, particularly in the early stage.

OBJECTIVES

Through the investigation of metabolic pathways, we endeavor to uncover the metabolomic characteristics associated with SEC states, and to examine the differential metabolites by which may exert their influence on thrombotic states.

METHODS

Patients with AF were enrolled, and the participants were divided into three groups based on the results of the echocardiogram: non-SEC, low-SEC and high-SEC group. Samples were collected and subjected to non-targeted metabolomics analysis. The analytical process included data quality control, metabolite difference analysis, component analysis, Kegg cluster analysis, etc. RESULTS: Our metabolic phenotype revealed a clear differential metabolic pattern between the SEC and non-SEC. Specifically, we identified 35 and 142 significantly differential metabolites in venous and atrial plasma, respectively, suggesting that SEC may be involved in pervasive metabolic dysregulation and that the degree of metabolic dysregulation in atrial plasma is more severe than that in venous blood.

CONCLUSION

Patients with SEC have a significantly different metabolic pattern compared to those without SEC. Our work promoted the understanding of mechanism of the occurrence and development of SEC, facilitated the screening of the target metabolites for its therapeutic intervention, and provided evidence for the prevention and treatment of SEC or thrombosis in AF. Our work also provided new directions for subsequent research in related fields. In conclusion, our study not only provides a theoretical basis for understanding the occurrence and development of SEC in AF, but also provides recommendations for the daily diet of AF patients with SEC, such as a balanced intake of essential amino acids, avoiding excessive intake of benzoic acid, and intake of appropriate inositol.

CLINICAL TRIAL NUMBER

Not applicable.