Thromboembolic risk factors and predictors of left atrial appendage thrombosis in Far North patients with nonvalvular atrial fibrillation

Aim. To analyze thromboembolic risk factors and identify additional predictors of left atrial appendage (LAA) thrombosis, which are not included in the CHA2DS2VASc scale, in long-term Far North residents with nonvalvular atrial fibrillation (AF).Material and methods. The study included 162 patients (men, 108; women, 54; mean age, 55,3±8,7 years) with non-valvular AF, living in the Far North, and 684 patients (men, 408; women, 276; mean age, 56,9±9,3 years), living in the temperate latitudes, hospitalized for catheter ablation. All patients underwent transthoracic and transesophageal echocardiography. According to transesophageal echocardiography, Far North patients were divided into two groups: group 1 — 21 patients with LAA thrombosis, group 2 — 141 patients without LAA thrombosis.Results. Compared to patients living in the temperate latitudes, Far North patients were younger (p=0,021) and were more likely to have type 2 diabetes (14,2% vs 8,3%, p=0,022), class ³II obesity (29,6% vs 21,1%, p=0,019), persistent AF(47,5% vs 33,2%, p=0,0019), LAA thrombosis (13% vs 6,6%, p=0,006), and severe structural and functional cardiac abnormalities (biatrial and right ventricular enlargement, lower left ventricular ejection fraction). In Far North patients, using logistic regression, independent predictors of LAA thrombosis were identified: an increase in left ventricular mass index (odds ratio (OR), 1,029; 95% confidence interval (CI), 1,011-1,048; p=0,001), persistent AF (OR, 3,521; 95% CI, 1,050-11,800; p=0,041).Conclusion. In Far North patients with nonvalvular AF, scheduled for catheter ablation, compared with patients from temperate latitudes, with a similar profile of cardiovascular diseases at a younger age, type 2 diabetes, grade ³II obesity, persistent AF, and LAA thrombosis were more common. The presence of persistent AF and an increase in left ventricular mass index are independent predictors of LAA thrombosis in Far North patients with nonvalvular AF

Fibrosis biomarkers as predictors of left atrial appendage thrombosis in patients with nonvalvular atrial fibrillation

Aim. To compare clinical, echocardiographic characteristics and blood biomarkers in patients with nonvalvular atrial fibrillation (AF) depending on the presence of left atrial appendage (LAA) thrombus and to identify independent predictors of LAA thrombosis.Material and methods. Patients with nonvalvular AF subjected to transesopha geal echocardiography before catheter ablation were divided into 2 groups comparable by sex and age: group 1 (n=45) — with LAA throm bosis; group 2 (n=97) — without LAA thrombosis. The patients underwent transthoracic and transesophageal echocardiography. In addition, the following blood biomarkers were analyzed: NT-proBNP (pg/ml), GDF-15 (pg/ml), TGF-β1 (pg/ml), PIIINP (ng/ml), high-sensitivity C-reactive protein (hsCRP) (mg/l), cystatin C (mg/l).Results. In group 1, persistent AF, coronary artery disease, heart failure were more often noted. In addition, group 1 patients had higher volume indices of both atria, left ventricular mass index and pulmonary artery systolic pressure, as well as lower left ventricular ejection fraction and blood flow velocity in the LAA. There were no differences in the groups in terms of the mean CHA2DS2VASc score, the proportion of patients taking oral anticoagulants (OAC), and the OAC spectrum. In group 1, higher levels of NT-proBNP (p=0,0001), GDF15 (p=0,0001), PIIINP (p=0,0002) were found with no differences in the levels of TGF-β1, hsCRP and cystatin C. A stepwise logistic regression revealed independent predictors of LAA thrombosis: LA volume index (ml/m2) — odds ratio (OR)=1,084, 95% confidence interval (CI) 1,028-1,143 (p=0,003); GDF15 ≥933 pg/ml — OR=3,054, 95% CI, 1,260-7,403 (p=0,013); PIIINP ≥68 pg/ml — OR=5,865, 95% CI, 2,404-14,308 (p<0,001). There were following model quality parameters: AUC=0,815 (p<0,001), specificity, 74,4%, sensitivity, 72,7%.Conclusion. In patients with nonvalvular atrial fibrillation taking OAC, serum levels of fibrosis biomarkers PIIINP ≥68 pg/mL and GDF-15 ≥933 pg/mL, along with the left atrial volume index, were independent predictors of LAA thrombosis

COMBINED ANTITHROMBOTIC THERAPY IN CASE OF PLANNED PERCUTANEOUS CORONARY INTERVENTIONS IN PATIENTS WITH ATRIAL FIBRILLATION IN ACTUAL CLINICAL PRACTICE

Retrospective analysis enrolled 124 patients (90 males and 34 females, mean age 67.2 ± 7.4 years) with stable coronary artery disease (CAD) and non-valvular atrial fibrillation (AF) who underwent inpatient treatment in 2016 and 2017. All patients had planned percutaneous coronary intervention (PCI) performed. As a part of combined antithrombotic therapy 104 patients received peroral anticoagulants after planned PCI. It was demonstrated that the majority of AF patients after planned PCI got triple or double antithrombotic therapy including oral anticoagulants in actual clinical practice. Significant decrease of using antiaggregants combination only in patients of this category was stated. According to clinical observation a patient with high risk of thromboembolic complications, hemorrhage, macrohematuria and planned surgical intervention due to comorbidity after PCI received double antithrombotic therapy including clopidogrel and dabigatran 110 mg twice per 24 hours. No thrombotic complications of coronary atherosclerosis, cardioembolic complications, clinically relevant bleeding were noticed in long-term postsurgical period. Modern evidential basis of advantages of double antithrombotic therapy with direct oral anticoagulants was presented. It is crucially important for patients with high risk of hemorrhagic complications

Predictors of spontaneous echo contrast and left atrial appendage thrombosis in nonvalvular atrial fibrillation

Aim. To identify predictors of spontaneous echo contrast (SEC) and/or left atrial appendage (LAA) thrombosis in patients with nonvalvular atrial fibrillation (AF) who are referred for elective cardioversion or catheter ablation (CA).Material and methods. A retrospective analysis of data from 638 patients with nonvalvular AF who were hospitalized from 2014 to 2017 for cardioversion or CA was performed. All patients underwent diagnostic tests, including transthoracic and transesophageal echocardiography (TEE).Results. According to the TEE results, two groups of patients were formed: group 1 — 95 patients (14,9%) with signs of SEC and/or thrombosis in LAA; group 2 — 543 patients (85,1%) without SEC or thrombosis in LAA. Patients with the phenomenon of SEC and/or LAA thrombosis were older, had a higher risk on the CHA2DS2-VASc score. These patients were more likely to have coronary heart disease (CAD), hypertension, stage IIA chronic heart failure, obese class >II, persistent or permanent AF Patients in both groups did not differ in anticoagulant therapy. Patients in group 1 had a larger size of the left and right atria, right ventricle, left ventricular (LV) end-systolic and end-diastolic diameters, higher LV mass index, lower values of LV ejection fraction and blood flow velocity in LAA. Logistic regression revealed following independent predictors of SEC and/or LAA thrombosis: CAD (odds ratio (OR) 2,289; 95% confidence interval (CI) 1,313-3,990; p=0,003), persistent or permanent AF (OR 2,071; 95% CI 1,222-3,510; p=0,007), LA diameter >43 mm (OR 3,569; 95% CI 2,0822-6,117; p<0,001), concentric or eccentric LV hypertrophy (OR 2,230; 95% CI 1,302-3,819; p=0,003).Conclusion. As the result, all patients referring for CA or cardioversion, regardless of the CHA2DS2-VASc score, should underwent LAA. According to this study, the presence of CAD, persistent or permanent AF, LA diameter >43 mm, concentric or eccentric LV hypertrophy are independent predictors of SEC and/or LAA thrombosis

Assessment of the Herd Immunity to SARS-CoV-2 among the Population of the Leningrad Region during the COVID-19 Epidemic

The first case of COVID-19 was registered in the Leningrad Region on March 13, 2020. The period of increasing intensity of the epidemic process lasted 8 weeks. One month after reaching the maximum incidence rate, a study was organized to determine seroprevalence to COVID-19 among the population of the Region.Objective of the study was to determine the level and structure of community immunity to SARS-CoV-2 virus in the population of the Leningrad Region in the period of intensive COVID-19 transmission.Materials and methods. The work was carried out within the framework of the Rospotrebnadzor project on assessment of community immunity to the SARS-CoV-2 virus in the population of the Russian Federation. The content of antibodies to SARS-CoV-2 was determined applying ELISA using a kit for the analysis of human serum or blood plasma for the presence of specific IgG to the nucleocapsid of the SARS-CoV-2 virus , manufactured by the State Scientific Center of Applied Microbiology and Biotechnology (Obolensk) in accordance with the instructions for use.Results and discussion. The study has showed that the herd immunity of the population of the Leningrad Region was 20.7 %. The maximum level has been established in children 1–6 years old (42.3 %) and people over 70 years old (29.0 %). The highest level of seropositivity, except for children and older people, was found among the unemployed (25.1 %). The lowest level of seroprevalence was detected in civil servants (12.8 %) and military personnel (16.7 %). It has been shown that the risk of infection increases by 1.5 times in case of contacts with COVID-19 patients. After exposure to COVID-19 virus, antibodies are produced in 82.1 % of the cases. In individuals with a positive PCR test result obtained earlier, antibodies are detected in 82.8 % of cases. The share of asymptomatic forms among seropositive residents of the Leningrad Region was 86.9 %. The results of assessing the herd immunity to SARS-CoV-2 in the population of the Leningrad Region indicate that during the period of intensive COVID-19 transmission, an average level of seroprevalence was formed. A significant proportion of asymptomatic forms of infection characterizes the high intensity of the latently developing epidemic process. The results obtained should be taken into account when organizing preventive measures, including vaccination, and predicting morbidity rates