The association between platelet to lymphocyte ratio and left atrial appendage thrombogenic milieu in patients with non-valvular atrial fibrillation

Abstract

INTRODUCTION: To assess the diagnostic value of platelet to lymphocyte ratio (PLR) with respect to the risk of left atrial appendage thrombogenic milieu (LAA TM) in patients with nonvalvular atrial fibrillation (AF), which has not been studied before. METHODS: This is a retrospective study that included consecutive patients with non-valvular AF who underwent transesophageal echocardiography (TEE) prior to electrical cardioversion or prior to AF catheter ablation. The potential association between PLR and LAA TM, which was defined as the presence of a thrombus, sludge and spontaneous echo contrast in LAA, was analyzed using multivariate logistic regression analysis. RESULTS: A total of 120 patients (59 females, mean age: 66.15 +- 10.2 years) with nonvalvular AF were included in the study. The thrombogenic milieu was determined in 37 (30.83%) patients on TEE examination. Patients with LAA TM were found to have a higher mean CHA2DS2-VASc score (3.00 vs. 2.00, p=0.009), decreased LAA velocity (23.60 vs. 36.20 m/s, p=0.002) and left ventricular ejection fraction (49.70 vs. 56.90 %, p=0.010), greater left atrial diameter (4.70 vs. 4.30 cm, p= 0.001) and higher PLR value (157.91 vs. 126.13, p=0.023) compared to those without thrombogenic milieu. Only LAA velocity (OR=0.854; p=0.001) and PLR (OR=1.024; p=0.012) were found to be independently associated with LAA TM. DISCUSSION AND CONCLUSION: PLR may be an independent risk factor for LAA TM in nonvalvular AF patients; however, beyond research purposes, the rather low sensitivity and specificity values must be interpreted with caution in the routine clinical setting.

Keywords

• atrial fibrillation
• platelet to lymphocyte ratio
• left atrial appendage thrombogenic milieu.