A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography
BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a high risk of stroke. This study was designed to investigate the relationship between hemodynamic parameters and left atrial thrombus/spontaneous echo contrast (LAT/SEC) in non-valvular atrial fibrillati...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2024-02-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1337853/full |
| _version_ | 1797321019326726144 |
|---|---|
| author | Decai Zeng Xiaofeng Zhang Shuai Chang Yanfen Zhong Yongzhi Cai Tongtong Huang Ji Wu |
| author_facet | Decai Zeng Xiaofeng Zhang Shuai Chang Yanfen Zhong Yongzhi Cai Tongtong Huang Ji Wu |
| author_sort | Decai Zeng |
| collection | DOAJ |
| description | BackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a high risk of stroke. This study was designed to investigate the relationship between hemodynamic parameters and left atrial thrombus/spontaneous echo contrast (LAT/SEC) in non-valvular atrial fibrillation (NVAF) patients and establish a predictive nomogram that integrates hemodynamic parameters with clinical predictors to predict the risk of LAT/SEC.MethodsFrom January 2019 to September 2022, a total of 354 consecutive patients with NVAF were enrolled in this cross-sectional study at the First Affiliated Hospital of Guangxi Medical University. To identify the optimal predictive features, we employed least absolute shrinkage and selection operator (LASSO) regression. A multivariate logistic regression model was subsequently constructed, and the results were visualized with a nomogram. We evaluated the model's performance using discrimination, calibration, and the concordance index (C-index).ResultsWe observed a 38.7% incidence of SEC/TH in NVAF patients. Independent influencing factors of LAT/SEC were identified through LASSO and multivariate logistic regression. Finally, four indicators were included, namely, previous stroke/transient ischaemic attack (OR = 4.25, 95% CI = 1.57–12.23, P = 0.006), left atrial volume index (LAVI) (OR = 1.04, 95% CI = 1.01–1.06, P = 0.001), S/D ratio (OR = 0.27, 95% CI = 0.11–0.59, P = 0.002), and left atrial acceleration factor (OR = 4.95, 95% CI = 2.05–12.79, P = 0.001). The nomogram, which incorporated these four influencing factors, demonstrated excellent predictive ability. The training set had a C-index of 0.878, while the validation set had a C-index of 0.872. Additionally, the calibration curve demonstrated great consistency between the predicted probabilities and the observed outcomes, and the decision curve analysis confirmed the important clinical advantage of the model for patients with NVAF.ConclusionOur findings indicate that an enlarged left atrium and abnormal hemodynamic parameters in the left atrial and pulmonary veins are linked to a greater risk of LAT/SEC. Previous stroke/transient ischaemic attack, LAVI, the S/D ratio, and left atrial acceleration factor were independently associated with LAT/SEC in NVAF patients. With the incorporation of these four variables, the developed nomogram effectively predicts the risk of LAT/SEC and outperforms the CHA2DS2-VASc score. |
| first_indexed | 2024-03-08T04:51:27Z |
| format | Article |
| id | doaj.art-3da3798a5d9d4ed1897eb4914ef400ec |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-08T04:51:27Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-3da3798a5d9d4ed1897eb4914ef400ec2024-02-08T04:52:58ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2024-02-011110.3389/fcvm.2024.13378531337853A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiographyDecai ZengXiaofeng ZhangShuai ChangYanfen ZhongYongzhi CaiTongtong HuangJi WuBackgroundAtrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a high risk of stroke. This study was designed to investigate the relationship between hemodynamic parameters and left atrial thrombus/spontaneous echo contrast (LAT/SEC) in non-valvular atrial fibrillation (NVAF) patients and establish a predictive nomogram that integrates hemodynamic parameters with clinical predictors to predict the risk of LAT/SEC.MethodsFrom January 2019 to September 2022, a total of 354 consecutive patients with NVAF were enrolled in this cross-sectional study at the First Affiliated Hospital of Guangxi Medical University. To identify the optimal predictive features, we employed least absolute shrinkage and selection operator (LASSO) regression. A multivariate logistic regression model was subsequently constructed, and the results were visualized with a nomogram. We evaluated the model's performance using discrimination, calibration, and the concordance index (C-index).ResultsWe observed a 38.7% incidence of SEC/TH in NVAF patients. Independent influencing factors of LAT/SEC were identified through LASSO and multivariate logistic regression. Finally, four indicators were included, namely, previous stroke/transient ischaemic attack (OR = 4.25, 95% CI = 1.57–12.23, P = 0.006), left atrial volume index (LAVI) (OR = 1.04, 95% CI = 1.01–1.06, P = 0.001), S/D ratio (OR = 0.27, 95% CI = 0.11–0.59, P = 0.002), and left atrial acceleration factor (OR = 4.95, 95% CI = 2.05–12.79, P = 0.001). The nomogram, which incorporated these four influencing factors, demonstrated excellent predictive ability. The training set had a C-index of 0.878, while the validation set had a C-index of 0.872. Additionally, the calibration curve demonstrated great consistency between the predicted probabilities and the observed outcomes, and the decision curve analysis confirmed the important clinical advantage of the model for patients with NVAF.ConclusionOur findings indicate that an enlarged left atrium and abnormal hemodynamic parameters in the left atrial and pulmonary veins are linked to a greater risk of LAT/SEC. Previous stroke/transient ischaemic attack, LAVI, the S/D ratio, and left atrial acceleration factor were independently associated with LAT/SEC in NVAF patients. With the incorporation of these four variables, the developed nomogram effectively predicts the risk of LAT/SEC and outperforms the CHA2DS2-VASc score.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1337853/fullnon-valvular atrial fibrillationnomogramspontaneous echo contrast (SEC)thrombushemodynamic parameters |
| spellingShingle | Decai Zeng Xiaofeng Zhang Shuai Chang Yanfen Zhong Yongzhi Cai Tongtong Huang Ji Wu A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography Frontiers in Cardiovascular Medicine non-valvular atrial fibrillation nomogram spontaneous echo contrast (SEC) thrombus hemodynamic parameters |
| title | A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography |
| title_full | A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography |
| title_fullStr | A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography |
| title_full_unstemmed | A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography |
| title_short | A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography |
| title_sort | nomogram for predicting left atrial thrombus or spontaneous echo contrast in non valvular atrial fibrillation patients using hemodynamic parameters from transthoracic echocardiography |
| topic | non-valvular atrial fibrillation nomogram spontaneous echo contrast (SEC) thrombus hemodynamic parameters |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1337853/full |
| work_keys_str_mv | AT decaizeng anomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT xiaofengzhang anomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT shuaichang anomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT yanfenzhong anomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT yongzhicai anomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT tongtonghuang anomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT jiwu anomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT decaizeng nomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT xiaofengzhang nomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT shuaichang nomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT yanfenzhong nomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT yongzhicai nomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT tongtonghuang nomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography AT jiwu nomogramforpredictingleftatrialthrombusorspontaneousechocontrastinnonvalvularatrialfibrillationpatientsusinghemodynamicparametersfromtransthoracicechocardiography |