Mean Platelet Volume to Platelet Count Ratio Predicts Left Atrial Stasis in Patients with Non-Valvular Atrial Fibrillation

Abstract

Background

The mean platelet volume to platelet count ratio (MPV/PC) has been investigated in the diagnosis, prognosis and risk stratification in several diseases. However, the predictive role of MPV/PC in left atrial stasis (LAS) of non-valvular atrial fibrillation (NVAF) patients remains unknown.

Methods

A total of 217 consecutive NVAF patients undergoing transesophageal echocardiogram (TEE) evaluation were retrospectively enrolled. The demographic, clinical, admission laboratory and TEE data were extracted and analyzed. Patients were categorized into those with or without LAS. The associations between the MPV/PC ratio and LAS were assessed by multivariate logistic regression analysis.

Results

There were 24.9% (n = 54) patients with LAS according to TEE. Compared with patients without LAS, the MPV/PC ratio was significantly higher in those with LAS (5.6±1.6 vs 4.8±1.0, P < 0.001). After multivariable adjustment, higher MPV/PC ratio levels (OR 1.747, 95% CI 1.193–2.559, P = 0.004) were positively associated with LAS, with the optimal cut-point for LAS prediction of 5.36 (area under the curve, AUC = 0.683, sensitivity 48%, specificity 73%, 95% CI 0.589–0.777, P < 0.001). The stratification analysis showed that a significant positive correlation between MPV/PC ratio ≥5.36 and LAS in patients of male, younger (<65 years), paroxysmal AF, without history of stroke/TIA, CHA₂DS₂-VASc score ≥2, left atrial diameter (LAD) ≥40mm and left atrial volume index (LAVI) >34mL/m² (all P < 0.05).

Conclusion

Increasing MPV/PC ratio was associated with an increased risk of LAS, which was mainly reflected in the subgroups of male, younger (<65 years), paroxysmal AF, without history of stroke/TIA, CHA₂DS₂-VASc score ≥2, LAD ≥40mm and LAVI >34mL/m² patients.

Graphical Abstract

Keywords:

• non-valvular atrial fibrillation
• mean platelet volume to platelet count ratio
• left atrial appendage thrombus
• spontaneous echo contrast

Abbreviations

AF, atrial fibrillation; AUC, area under the curve; BSA, body surface area; CI, confidence interval; LAA, left atrial appendage; LAD, left atrial dimension; LAS, left atrial stasis; LAT, left atrial thrombus; LAV, left atrial volume; LAVI, left atrial volume index; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; NOAC, new oral anticoagulant; NVAF, nonvalvular atrial fibrillation; OR, odds-ratio; RFCA, radiofrequency catheter ablation; SEC, spontaneous echo contrast; TEE, transesophageal echocardiography; TIA, transient ischaemic attack; MPV/PC ratio, the ratio of the mean platelet volume to platelet count.

Ethics Approval and Consent to Participate

This study was approved by the Institutional Review Board of Beijing Friendship Hospital, Capital Medical University, and written informed consent was obtained from all patients.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

All authors declare that they have no competing interests.