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A nomogram for predicting left atrial thrombus or spontaneous echo contrast in non-valvular atrial fibrillation
Decai Zeng1, Xiaofeng Zhang1, Shuai Chang1
1Department of Ultrasound, First Affiliated Hospital, Guangxi Medical University, Nanning, China.
Insights
This study developed a nomogram to predict left atrial thrombus/spontaneous echo contrast in non-valvular atrial fibrillation patients. The nomogram integrates clinical factors and hemodynamic parameters, offering improved risk prediction over existing scores.
Area of Science:
- Cardiology
- Medical Imaging
- Predictive Analytics
Background:
- Atrial fibrillation (AF) is a common arrhythmia linked to increased stroke risk.
- Left atrial thrombus/spontaneous echo contrast (LAT/SEC) is a significant complication in non-valvular atrial fibrillation (NVAF).
- Accurate risk stratification for LAT/SEC is crucial for stroke prevention strategies.
Purpose of the Study:
- To investigate the relationship between hemodynamic parameters and LAT/SEC in NVAF patients.
- To develop and validate a predictive nomogram integrating hemodynamic and clinical factors for LAT/SEC risk.
- To compare the predictive performance of the developed nomogram against the CHA₂DS₂-VASc score.
Main Methods:
- A cross-sectional study involving 354 NVAF patients.
- Utilized Least Absolute Shrinkage and Selection Operator (LASSO) regression to identify key predictive features.
- Constructed a multivariate logistic regression model and visualized it as a nomogram, with performance evaluated by discrimination, calibration, and C-index.
Main Results:
- The incidence of SEC/TH was 38.7% in the studied NVAF population.
- Independent predictors for LAT/SEC included prior stroke/TIA, left atrial volume index (LAVI), S/D ratio, and left atrial acceleration factor.
- The nomogram demonstrated excellent predictive ability with C-indices of 0.878 (training) and 0.872 (validation).
Conclusions:
- Enlarged left atrium and abnormal hemodynamic parameters are associated with increased LAT/SEC risk.
- The developed nomogram, incorporating previous stroke/TIA, LAVI, S/D ratio, and left atrial acceleration factor, effectively predicts LAT/SEC.
- The nomogram shows superior predictive performance compared to the CHA₂DS₂-VASc score for NVAF patients.
Background:
Atrial 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.
Methods:
From 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).
Results:
We 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.
Conclusion:
Our 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.
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