Predictive value of transesophageal echocardiography combined with serum triglyceride glucose product index for left atrial appendage thrombosis patients with non valvular atrial fibrillation
LI Ke-wei
CHEN Jiao-yan
CAO Jing
GUO Li-yan
Abstract：Objective To explore the predictive value of transesophageal echocardiography(TEE)combined with serum triglyceride glucose(TyG)product index for left atrial appendage thrombosis(LAAT)in patients with non valvular atrial fibrillation(NVAF).Methods The clinical data from 260 patients with NVAF at Linfen People's Hospital from October 2023 to January 2025 were retrospective selected and the patients were categorized into LAAT group(n=62)and non LAAT group(n=198)based on the presence or absence of LAAT formation.The general information,TEE parameters[left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),left atrial diameter(LAD),left atrial appendage emptying velocity(LAAeV),left atrial appendage filling velocity(LAAfV)and three-dimensional volumetric ejection fraction(3D-EF)]and serum TyG index were compared between the two groups.The influencing factors of LAAT formation in NVAF patients were analyzed;the dose-response relationship between TEE parameters and serum TyG index and LAAT formation was analyzed and the value of predicting LAAT formation was analyzed.Results The incidence of LAAT formation in NVAF patients was 23.85%.The proportion of cauliflower-shaped LAA,CHA2DS2-VASc score,plasma N-terminal pro-brain natriuretic peptide(NT-proBNP)level and serum TyG index in LAAT group were higher than those in non-LAAT group[29.03%vs.12.12%、(3.94±1.12)scores vs.(2.40±0.56)scores、(1220.39±262.87)pg/ml vs.(986.54±231.54)pg/ml、(8.65±1.42)vs.(7.01±1.19),all P<0.05];LVEF,LAAeV,LAAfV and 3D-EF were lower than in the non-LAAT group[(55.37±6.48)%vs.(58.81±6.12)%、(51.62±6.13)cm/s vs.(59.16±6.52)cm/s、(48.74±5.86)cm/s vs.(57.32±6.17)cm/s、(40.35±3.57)%vs.(47.08±4.23)%,all P<0.05].Cauliflower-shaped LAA,CHA2DS2-VASc score and serum TyG index were the independent risk factors for LAAT formation in NVAF patients;LAAeV,LAAfV and 3D-EF were the independent protective factors(P<0.05).There was a negative linear dose-response relationship between LAAeV,LAAfV and 3D-EF and LAAT formation in NVAF patients,and a positive linear dose-response relationship between serum TyG index and LAAT formation in NVAF patients(P<0.05).The area under the curve(AUC)of LAAeV,LAAfV,3D-EF and serum TyG index for predicting LAAT formation in NVAF patients were 0.736,0.752,0.726 and 0.748,respectively.The AUC predicted by LAAeV,LAAfV,3D-EF combined with serum TyG index was 0.877,which was greater than the AUC predicted by each index alone and CHA2DS2-VASc score(AUC was 0.809)(P<0.05).Compared with CHA2DS2-VASc score,the net reclassification index(NRI)and comprehensive discriminant improvement index(IDI)of LAAeV,LAAfV and 3D-EF combined with serum TyG index were both>0(P<0.05).The prediction of LAAeV,LAAfV and 3D-EF combined with serum TyG index had a significant positive net benefit and had a good clinical effect in predicting LAAT formation in NVAF patients.Conclusion The LAAeV,LAAfV and 3D-EF of TEE parameters and serum TyG index have the certain value in the formation of LAAT in NVAF patients and their combined application can provide reliable evidence for clinically identifying the patients at high risk of LAAT formation.
Keywords：Non valvular atrial fibrillationLeft atrial appendage thrombosisTransesophageal echocardiographyTriglyceride glucose product indexPrediction
Publication Date：2025-10-20
Online Publishing Date：2025-10-30(First online date of this platform, not the publication date of the document)
Pages：7( 930-936 )