Relative factors of left atrial appendage changes to major cardiovascular and cerebrovascular adverse events in patent foramen ovale with atrial fibrillation assessed by transesophageal echocardiography

WANG Xu; WANG Jun-wei; DU Li-jun

doi:10.3969/j.issn.1672-5301.2024.04.005

Abstract：Objective To investigate the correlation between the left atrial appendage changes of atrial fibrillation(AF)with patent foramen ovale(PFO)and major adverse cardiovascular and cerebrovascular events(MACCE)by transesophageal echocardiography.Methods A retrospective study was conducted on 167 patients with atrial fibrillation and patent foramen ovale admitted to the Handan First Hospital from March 2021 to January 2023.According to the occurrence of MACCE within 6 months,the patients were divided into MACCE group and non-MACCE group.The baseline data,left atrial appendage ejection fraction(LAAEF),left atrial appendage average blood flow emptying velocity(LAA-AEV),left atrial appendage maximum volume(LAAVmax),left atrial appendage peak blood flow emptying velocity(LAA-EV),left atrial appendage peak blood flow filling velocity(LAA-FV),left atrial appendage average blood flow filling velocity(LAA-AFV),left atrial appendage opening area(LAA-O),left atrial appendage length(LAA-L),and left atrial appendage width(LAA-W)were compared between the two groups.The random forest algorithm was used to rank the importance of the characteristic variables of MACCE,and the ROC analysis was used to predict the value of MACCE using transesophageal echocardiographic parameters.Results The proportion of patients with a history of transient ischemic attack in the MACCE group was higher than that in the non-MACCE group(27.27％vs.5.97％,P＜0.05);the LAAEF[(37.28±12.05)％vs.(49.20±10.34)％],LAA-AEV[(29.43±7.29)cm/s vs.(39.66±10.53)cm/s],and LAA-AFV[(24.35±5.82)cm/s vs.(35.29±9.10)cm/s]in the MACCE group were lower than those in the non-MACCE group,while the LAA-W[(21.13±4.29)mm vs.(18.74±3.06)mm]and spontaneous visualization grading were higher than those in the non-MACCE group(P＜0.05).The univariate analysis with P＜0.05 variables as the constituent variables of the random forest algorithm showed that the top five predictive factors for spontaneous visualization grading,LAA-AEV,LAA-AFV,LAAEF,and LAA-W were ranked in the top five by importance in the MACCE group;the ROC curve showed that the combined AUC of spontaneous visualization grading,LAA-AEV,LAA-AFV,LAAEF,and LAA-W was greater than that of each parameter alone,with the AUC of spontaneous visualization grading being the largest among single parameters.Conclusion In patients with atrial fibrillation and patent foramen ovale,transesophageal echocardiography is used to observe changes in the left atrial appendage,and spontaneous imaging classification,LAA-AEV,LAA-AFV,LAAEF,and LAA-W are combined to predict MACCE in patients with high value.