Predictive value of residual cholesterol inflammatory index for left atrial thrombus or spontaneous echo contrast in patients with nonvalvular atrial fibrillation with low CHA 2 DS 2 -VASc scores

Abstract Background Currently, clinical guidelines are controversial regarding anticoagulation in patients with nonvalvular atrial fibrillation (NVAF) with low CHA₂DS₂-VASc scores (0–1 in men and 1–2 in women). Although these patients have low CHA₂DS₂-VASc scores, they are still at risk for left atrial thrombus (LAT) or spontaneous echo contrast (SEC) and further thromboembolism. Studies have shown that residual cholesterol inflammatory index (RCII) can assess both residual cholesterol and low-grade inflammation and is associated with thromboembolism, but the relationship between RCII and LAT/SEC in patients with NVAF has not been clear. Therefore, this study aimed to evaluate the predictive power of RCII for the occurrence of LAT/SEC in NVAF patients with low CHA₂DS₂-VASc scores. Methods All patients included in the study underwent transesophageal echocardiography (TEE). According to the results of TEE, the patients were divided into the LAT/SEC group and non-LAT /SEC group. The risk factors of LAT/SEC were analyzed by binary logistic regression. The correlation factors were combined with the CHA₂DS₂-VASc scores to develop a new prediction model for LAT/SEC, and the predictive efficacy of each model for LAT/SEC was further evaluated by using receiver operating characteristic (ROC). Results A total of 967 patients with NVAF were included in the study. The RCII level in the LAT/SEC group was significantly higher than that in the non-LAT /SEC group. Increased RCII levels and increased left atrial diameter (LAD) were independent risk factors for the development of LAT/SEC. The incidence of LAT/SEC was higher in the highest quartile array of RCII (> 8.81) and LAD (> 39mm) than in the corresponding lowest quartile array. The CHA₂DS₂-VASc scores combined with RCII and LAD have good predictive power for LAT/SEC. Conclusions For NVAF patients with low CHA₂DS₂-VASc scores, increased RCII levels and enlarged LAD are risk factors for LAT/SEC. The CHA₂DS₂-VASc scores combined with RCII and LAD significantly improved the predictive power of LAT/SEC.