The diagnostic value of transesophageal echocardiography combined with serum ADAMTS13 and PCSK9 in detecting left atrial thrombus in patients with non-valvular atrial fibrillation
Chen Ziran
Wu Huajun
Huang Canbin
Qin Yufei
Abstract：Objective To explore the diagnostic value of transesophageal echocardiography(TEE)combined with serum a disintegrin and metalloproteinase with thrombospondin motifs 13(ADAMTS13)and proprotein convertase subtilisin/kexin type 9(PCSK9)levels in detecting left atrial thrombus in patients with non-valvular atrial fibrillation(NVAF).Methods Ninety-six NVAF patients admitted to the Department of Cardiovascular Medicine of Panyu Central Hospital Affiliated to Guangzhou Medical University from January 2022 to December 2024 were selected as the NVAF group.Based on the pres-ence of left atrial thrombus,patients were divided into a thrombus subgroup(n=42)and a non-thrombus subgroup(n=54).Additionally,100 healthy individuals undergoing physical examinations during the same period were selected as the healthy control group.Serum ADAMTS13 and PCSK9 levels were measured by ELISA.Multivariate logistic regression analysis was used to identify factors influencing left atrial thrombus formation in NVAF patients.Receiver operating characteristic(ROC)curve analysis was performed to evaluate the diagnostic value of TEE parameters and serum AD AMTS 13 and PCSK9 levels for left atrial thrombus.Results Compared with the healthy control group,the NVAF group showed decreased serum AD-AMTS13 levels and increased PCSK9 levels(t/P=42.277/＜0.001,42.537/＜0.001).The thrombus subgroup exhibited lower peak emptying velocity(PEV),3D ejection fraction(3D-EF),and serum ADAMTS13 levels,but higher serum PCSK9 levels compared to the non-thrombus subgroup(t/P=5.112/＜0.001,5.104/＜0.001,5.117/＜0.001,5.035/＜0.001).Multivariate logistic regression analysis indicated that high PCSK9 was an independent risk factor for left atrial thrombus[OR(95％CI)=2.287(1.443-3.625)],while high PEV,high 3D-EF,and high ADAMTS13 were independent protective factors[OR(95％CI)=0.714(0.600-0.850),0.725(0.604-0.870),0.718(0.605-0.851)].The AUC values for TEE parameters,serum ADAMTS13,PCSK9,and their combination in diagnosing left atrial thrombus were 0.861,0.894,0.851,0.863,and 0.966,respectively.Combined di-agnosis demonstrated superior efficacy compared to individual parameters(Z/P=3.190/＜0.001,2.652/＜0.001,3.261/＜0.001,2.830/＜0.001).Conclusion Decreased PEV,3D-EF,and serum ADAMTS13 levels,along with increased serum PCSK9 levels,are associated with left atrial thrombus formation in NVAF patients.The combination of TEE parameters with serum ADAMTS13 and PCSK9 levels provides valuable diagnostic information for detecting left atrial thrombus in NVAF patients.
Keywords：Non-valvular atrial fibrillationLeft atrial thrombusTransesophageal echocardiographyDisintegrin and metalloproteinase with thrombospondin motifs 13Proprotein convertase subtilisin/kexin type 9Diagnosis
Publication Date：2025-10-18
Online Publishing Date：2025-11-10(First online date of this platform, not the publication date of the document)
Pages：6( 1188-1193 )