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

Figures & data

Figure 1 Flow chart of study participants.

Table 1 Baseline Characteristics of Patients with or Without LAS (LAT and/or SEC)

Variable	Total (n=217)	LAS (n=54)	Without LAS (n=163)	P-value
Age, year	66.4±8.7	66.4±8.9	66.4±8.7	0.981
Male, n (%)	115 (53.0%)	36 (66.7%)	79 (48.5%)	0.020
BMI, Kg/m^2	25.9±4.7	25.7±4.8	26.4±4.2	0.360
AF
Persistent AF, n (%)	64 (29.5%)	29 (53.7%)	39 (21.5%)	<0.001
AF history, months	44.8±4.8	51.4±5.5	42.9±4.5	0.469
Laboratory data
Creatinine, μmol/L	70.4±15.3	71.3±14.9	70.1±16.3	0.106
Fibrinogen, mg/dL	2.8±0.7	3.0±0.9	2.8±0.7	0.703
CHA2DS2-VASc score	2.7±1.4	3.2±1.4	2.5±1.4	0.009
Congestive heart failure, n (%)	5 (2.3%)	2 (3.7%)	3 (1.8%)	0.600
Hypertension, n (%)	156 (71.9%)	37 (68.5%)	119 (73.0%)	0.525
Diabetes mellitus, n (%)	56 (25.8%)	18 (33.3%)	38 (23.3%)	0.145
Previous stroke/TIA, n (%)	38 (17.5%)	15 (27.7%)	23 (14.1%)	0.022
Vascular disease, n (%)	23 (10.6%)	6 (11.1%)	17 (10.4%)	0.888
Dyslipidemia, n (%)	55 (25.3%)	18 (33.3%)	37 (22.7%)	0.119
Echocardiographic parameters
LAD, mm	41.4±5.4	44.6±5.0	40.3±5.2	<0.001
LVEDD, mm	50.0±4.6	50.0±5.3	50.0±4.4	0.868
LVEF, %	64.5±8.2	62.2±8.0	65.2±8.2	0.040
LAA width, mm	17.9±4.2	19.4±4.3	17.4±4.1	0.008
LAA length, mm	29.0±5.6	30.3±5.3	28.1±5.7	0.324
LAA emptying velocity (cm/s)	47.3±14.1	39.5±14.6	50.2±12.8	<0.001
Antiplatelet & anticoagulant drugs, n (%)
Aspirin, n (%)	51 (23.5%)	10 (18.5)	41 (25.2%)	0.276
Warfarin, n (%)	31 (14.3%)	11 (20.4%)	20 (12.3%)
NOAC, n (%)	25 (11.5%)	7 (13.0%)	18 (11.0%)
MPV/PC ratio	5.0±1.2	5.6±1.6	4.8±1.0	<0.001

Abbreviations: AF, atrial fibrillation; LAA, left atrial appendage; LAD, left atrial dimension; LAS, left atrial stasis; LAT, left atrial thrombus; LVEDD, left ventricular end-diastolic dimension; LVEF, left ventricular ejection fraction; NOAC, new oral anticoagulant; SEC, spontaneous echo contrast; TIA, transient ischaemic attack; MPV/PC ratio, the ratio of the mean platelet volume to platelet count.

Table 2 Univariate and Multivariate Regression Analysis for LAS (LAT and/or SEC)

Variables	Univariate Analysis		Multivariate Analysis
	OR (95% CI)	P value	OR (95% CI)	P value
Age	1.000 (0.961–1.042)	0.981	0.952 (0.897–1.009)	0.100
Male sex	2.098 (1.010–4.359)	0.047	0.528 (0.194–1.437)	0.211
Persistent AF	4.394 (2.092–9.228)	<0.001	2.152 (0.838–5.526)	0.111
CHA2DS2-VASc score	1.569 (1.239–1.988)	<0.001	1.612 (1.130–2.299)	0.008
Previous stroke/TIA	2.417 (1.018–5.742)	0.046	1.209 (0.357–4.089)	0.761
LAD	4.653 (2.204–9.826)	<0.001	2.031 (0.783–5.270)	0.145
LAA width	3.306 (1.300–7.909)	0.010	2.079 (0.717–6.031)	0.178
LAA emptying velocity	0.936 (0.906–0.967)	<0.001	0.969 (0.931–1.009)	0.130
MPV/PC ratio	1.772 (1.288–2.437)	<0.001	1.693 (1.168–2.454)	0.005

Abbreviations: AF, atrial fibrillation; CI, confidence interval; OR, odds ratio; LAA, left atrial appendage; LAD, left atrial dimension; LAS, left atrial stasis; LAT, left atrial thrombus; MPV/PC ratio, the ratio of the mean platelet volume to platelet count; SEC, spontaneous echo contrast; TIA, transient ischaemic attack.

Figure 2 Receiver operating characteristic curve for MPV/PC ratio and MPV or PC alone in predicting LAS in patients with NVAF. The MPV/PC ratio was a better predictor than either MPV or PC alone.

Table 3 Incidences of LAS in Different Potential Covariates

Age	<65 (n=90, 41.5%)			≥65 Years (n=127, 58.5%)
	LAS(+)	LAS(-)	P	LAS(+)	LAS(-)	P
MPV/PC<5.36	3	16	0.385	5	25	0.218
MPV/PC≥5.36	19	52		27	70
Sex	Male (n=115, 53.0%)			Female (n=102, 47.0%)
	LAS(+)	LAS(-)	P	LAS(+)	LAS(-)	P
MPV/PC<5.36	14	54	0.003	12	68	0.210
MPV/PC≥5.36	22	25		6	16
AF	Paroxysmal (n=152, 70.0%)			Persistent (n=65, 30.0%)
	LAS(+)	LAS(-)	P	LAS(+)	LAS(-)	P
MPV/PC<5.36	11	97	0.001	16	25	0.236
MPV/PC≥5.36	14	30		13	11
Previous stroke/TIA	Without (n=179, 82.5%)			With (n=38, 17.5%)
	LAS(+)	LAS(-)	P	LAS(+)	LAS(-)	P
MPV/PC<5.36	29	121	0.070	10	20	0.223
MPV/PC≥5.36	10	19		5	3
LAD	<40mm (n=91, 41.9%)			≥40mm (n=126, 58.1%)
	LAS(+)	LAS(-)	P	LAS(+)	LAS(-)	P
MPV/PC<5.36	8	65	0.450	18	57	0.004
MPV/PC≥5.36	3	15		25	26
CHA2DS2-VASc	<2 (n=63, 29.0%)			≥2 (n=154, n=71.0%)
	LAS(+)	LAS(-)	P	LAS(+)	LAS(-)	P
MPV/PC<5.36	3	47	1.000	23	75	0.002
MPV/PC≥5.36	1	12		27	29

Abbreviations: AF, atrial fibrillation; LAD, left atrial dimension; LAS, left atrial stasis; TIA, transient ischaemic attack; MPV/PC ratio, the ratio of the mean platelet volume to platelet count.

Figure 3 Proportion of the participants with LAS stratified by age, sex, types of AF, previous history of stroke/TIA, CHA₂DS₂-VASc score, LAD and LAVI. *P < 0.05.

Abbreviations: AF, atrial fibrillation; LAD, left atrial dimension; LAVI, left atrial volume index; TIA, transient ischaemic attack; MPV/PC ratio, the ratio of the mean platelet volume to platelet count.

Figure 4 Effects of the MPV/PC ratio on LAS by prespecified subgroups. Prespecified subgroups of interest in this analysis are age (A), sex (B), types of AF (C), previous history of stroke/TIA (D), CHA₂DS₂-VASc score (E), LAD (F) and LAVI (G).