Related Experiment Video

Updated: May 5, 2026

Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation

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Fibrosis-4 Index as a Marker of Systemic Fibrotic Burden and Its Association with Left Atrial Thrombus in Nonvalvular

Habibe Kafes1, Nedret Ulvan1

  • 1Department of Cardiology, Ankara City Hospital, University of Health Sciences, 06800 Ankara, Turkey.

Journal of Clinical Medicine
|May 4, 2026
PubMed

Insights

The Fibrosis-4 (FIB-4) index, a marker of systemic fibrosis, is independently associated with left atrial thrombus (LAT) in patients with nonvalvular atrial fibrillation (AF). This simple, noninvasive marker may indicate a pro-thrombotic state.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Biomarkers

Background:

  • Left atrial thrombus (LAT) is a significant complication in nonvalvular atrial fibrillation (AF).
  • The Fibrosis-4 (FIB-4) index is a noninvasive marker of systemic fibrotic burden.
  • The relationship between FIB-4 and LAT in AF patients requires further investigation.

Purpose of the Study:

  • To investigate the association between the FIB-4 index and the presence of LAT in patients with nonvalvular paroxysmal AF.
  • To determine if FIB-4 can serve as an independent predictor of LAT.

Main Methods:

  • Retrospective study of 859 patients with nonvalvular paroxysmal AF undergoing transesophageal echocardiography (TEE).
  • Analysis included ROC analysis and multivariable logistic regression, adjusting for CHA2DS2-VASc score and other clinical factors.
  • Spearman's correlation was used to assess the relationship between FIB-4 and CHA2DS2-VASc score.

Main Results:

  • Left atrial thrombus (LAT) was detected in 10.2% of patients.
  • Patients with LAT had significantly higher FIB-4 scores (1.5 vs. 1.1, p < 0.001).
  • A FIB-4 cut-off of 1.47 was identified as an independent predictor of LAT (OR: 5.200, p < 0.001), though it did not improve the discriminatory performance of the CHA2DS2-VASc score.

Conclusions:

  • Elevated FIB-4 index is independently associated with LAT in patients with paroxysmal AF.
  • FIB-4 may reflect a systemic fibro-inflammatory state contributing to atrial thrombogenesis.
  • FIB-4 represents a potential noninvasive biomarker for assessing thrombotic risk in AF.

Keywords:
atrial fibrillationbiomarkersfibrosis-4 indexleft atrial thrombustransesophageal echocardiography

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