Atrial fibrillation (AF) is a common arrhythmia with high risk for systemic embolism. This depends on left atrial (LA) mechanical and haematological factors. The inflammation enhances platelet activation, endothelial damage and interaction between platelets and neutrophils. Inflammatory markers as pentraxin 3 (PTX3) are elevated in patients with dilated LA with poorly functioning left atrial appendage (LAA). Many clinical schemes were proposed to assess risk of stroke as CHA2DS2-VASc. However, they need to be refined with incorporation of some echocardiographic and laboratory parameters.
Objectives: To compare the sensitivity and specificity of CHA2DS2-VASc score alone, with addition of serum PTX3 and with addition of serum PTX3 and LAA tissue Doppler velocity.
Patients and Methods:
The study included 80 patients with non-valvular AF (NVAF) were enrolled. CHA2DS2-VASc score was calculated for every patient. Serum PTX3 was measured within 1 week before the transesophageal echocardiographic examination. LA size and volume and LAA tissue Doppler velocity were measured by trans-thoracic echocardiography (TTE). LAA thrombi were reported by trans-esophageal echocardiography (TEE).
Results:
The mean age was 59.2±8.3 years with 47 patients (58.8%) were males. By TEE, 13 patients (16.25%) were found to have LAA thrombi. Using ROC statistic, a cut-off value of 11.98 mg/dl for serum PTX3 (sensitivity: 92%, specificity: 55%) and 8.4 cm/sec. for LAA tissue Doppler velocity (sensitivity: 53.8%, specificity: 88%) were set. According to CHA2DS2-VASc score, 31 patients (38.75%) were considered to be at high risk for stroke (sensitivity: 92%, specificity: 55%). Combining the above three parameters improves both sensitivity (99%) and specificity (100%).
Conclusion: Adding some echocardiographic and laboratory parameters as serum PTX3 to the clinical risk score CHA2DS2-VASc will improve both sensitivity and specificity in predicting high risk patients. This will better guide anti-thrombotic therapy in NVAF patients.