Department of Cardiology, Bülent Ecevit University Faculty of Medicine Medical Center, Zonguldak, Turkey.
Nutr Metab Cardiovasc Dis. 2020 Jun 25;30(7):1152-1160. doi: 10.1016/j.numecd.2020.03.023. Epub 2020 Apr 9.
We determined the association between left atrial (LA) thrombus occurrence and a non-classic risk marker, plasma levels of vitamin D, in atrial fibrillation (AF) patients on continuous non-vitamin K antagonist oral anticoagulant (NOAC) therapy for ≥4 weeks. Low levels of plasma 25-hydroxy vitamin D (25-OHD) are predictive of fatal stroke. Vitamin D has anticoagulant effects on the coagulation cascade, which are indirectly targeted by NOAC therapy. The impact of plasma levels of vitamin D on the rate of LA thrombus detected by transesophageal echocardiography (TEE) in AF patients is unknown.
We enrolled 201 (133 female) AF patients who were using continuous NOAC therapy for ≥4 weeks. All patients underwent transthoracic and TEE examination. Serum concentrations of 25-OHD, C-reactive protein (CRP) levels, CHADS-VASc scores and parameters, LA size, and left ventricle ejection fraction (LVEF) were examined before the TEE procedure. LA thrombus occurrence was independently associated with serum levels of 25-OHD (OR: 0.884; 95% CI: 0.839-0.932; P < 0.001), LA diameter (OR: 1.120; 95% CI: 1.038-1.209; P = 0.003), and LVEF(OR: 0.944; 95% CI: 0.896-0.995; P = 0.032). Dense spontaneous echo contrast (SEC) presence was also inversely associated with 25-OHD concentrations.
Low 25-OHD levels, as a non-classic risk factor, were independently and significantly associated with dense SEC and LA thrombus occurrence in AF patients under NOAC therapy, as well as LA enlargement and decreased LVEF. Further large-scale studies are needed to explain the role of vitamin D deficiency, or efficacy of replacement, on LA thrombus occurrence.
我们旨在确定左心房（LA）血栓形成与非经典风险标志物之间的关联，即 25-羟维生素 D（25-OHD）水平，在接受连续非维生素 K 拮抗剂口服抗凝剂（NOAC）治疗≥4 周的心房颤动（AF）患者中。低水平的血浆 25-羟维生素 D（25-OHD）可预测致命性卒中。维生素 D 对凝血级联具有抗凝作用，而 NOAC 治疗则间接靶向该作用。维生素 D 水平对 AF 患者经食管超声心动图（TEE）检测到的左心房血栓形成率的影响尚不清楚。
我们纳入了 201 名（女性 133 名）正在接受连续 4 周以上 NOAC 治疗的 AF 患者。所有患者均接受了经胸和 TEE 检查。TEE 检查前检测血清 25-OHD、C 反应蛋白（CRP）水平、CHADS-VASc 评分和参数、左心房大小和左心室射血分数（LVEF）。LA 血栓形成的发生与血清 25-OHD 水平（OR：0.884；95%CI：0.839-0.932；P<0.001）、LA 直径（OR：1.120；95%CI：1.038-1.209；P=0.003）和 LVEF（OR：0.944；95%CI：0.896-0.995；P=0.032）独立相关。密集型自发性回声对比（SEC）的存在也与 25-OHD 浓度呈负相关。
作为非经典危险因素，低 25-OHD 水平与 AF 患者在 NOAC 治疗下的 SEC 密集和 LA 血栓形成、LA 扩大和 LVEF 降低独立且显著相关。需要进一步的大规模研究来解释维生素 D 缺乏或替代治疗对 LA 血栓形成的作用。
