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Lipoprotein(a), left atrial appendage function and thromboembolic risk in patients with chronic nonvalvular atrial
Y Igarashi1, H Kasai, F Yamashita
1Department of Medicine, Tsuruoka City Shonai Hospital, Japan.
Insights
High lipoprotein(a) (Lp(a)) levels and low left atrial appendage (LAA) flow velocity are independent predictors of thromboembolism in patients with nonvalvular atrial fibrillation (NVAF). These findings highlight potential biomarkers for stroke risk in NVAF patients.
Area of Science:
- Cardiology
- Thrombosis Research
- Biomarkers
Background:
- Lipoprotein(a) (Lp(a)) influences the fibrinolytic system, suggesting a prothrombotic role.
- Nonvalvular atrial fibrillation (NVAF) is a significant risk factor for thromboembolic events, necessitating better risk stratification.
Purpose of the Study:
- To investigate the association between serum Lp(a) levels and the risk of thromboembolism in patients with chronic NVAF.
- To identify independent predictors of thromboembolism in this patient cohort.
Main Methods:
- Collected clinical, laboratory, and transesophageal echocardiographic data from 172 non-anticoagulated patients with chronic NVAF.
- Compared characteristics between patients with and without recent embolic events or left atrial thrombus.
- Utilized multivariate analysis to identify independent predictors of thromboembolism.
Main Results:
- The thromboembolic group exhibited higher Lp(a) concentrations (median 31.5 vs. 15.5 mg/dl) and reduced left atrial appendage (LAA) flow velocities (median 9.5 vs. 21.2 cm/s).
- Independent predictors of thromboembolism included Lp(a) level ≥30 mg/dl (OR 9.5), LAA flow velocity <20 cm/s (OR 8.7), and fibrinogen concentration <377 mg/dl (OR 3.2).
Conclusions:
- Elevated serum Lp(a) levels and reduced LAA flow velocities are independently associated with an increased risk of thromboembolism in chronic NVAF.
- These factors may serve as valuable biomarkers for assessing stroke risk in NVAF patients.
Abstract:
Lipoprotein(a) (Lp(a)) has a prothrombotic effect by modulating the fibrinolytic system. The purpose of the present study was to determine whether serum Lp(a) levels are associated with an increased risk of thromboembolism in chronic nonvalvular atrial fibrillation (NVAF). Clinical, laboratory and transesophageal echocardiographic data were collected in 172 consecutive, non-anticoagulated patients with chronic NVAF. Thirty-four patients (thromboembolic group) had a recent (<1 month) embolic event and/or a left atrial thrombus on transesophageal echocardiography. The thromboembolic group had a higher frequency of spontaneous echo contrast (94 vs. 58%, p<0.0001), increased concentrations of Lp(a) (median: 31.5 vs. 15.5 mg/dl, p<0.0001) and fibrinogen (median: 352 vs. 314 mg/dl, p = 0.0015), larger left atrial dimensions (median: 5.1 vs. 4.8cm, p = 0.0078), and reduced left atrial appendage (LAA) flow velocities (median: 9.5 vs. 21.2 cm/s, p<0.0001) than the nonthromboembolic group. Multivariate analysis identified 3 independent predictors of thromboembolism: Lp(a) level > or =30 mg/dl (odds ratio (OR) 9.5, 95% confidence interval (CI) 4.4-20.4, p<0.0001), LAA flow velocity of <20 cm/s (OR 8.7, 95% CI 3.3-23.0, p = 0.0003) and a fibrinogen concentration of <377mg/dl (OR 3.2, 95% CI 1.5-6.9, p = 0.0201). The Lp(a) elevations and reduced LAA flow velocities are independently associated with thromboembolism in chronic NVAF.