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Serum heparanase levels and left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation

Serumheparanasespiegel und linksatrialer Thrombus/Thrombus im linken Herzohr bei Patienten mit nichtvalvulärem Vorhofflimmern

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Abstract

Introduction

Data regarding the possible role of heparanase (HPA) in the occurrence of left atrial/left atrial appendage (LA/LAA) thrombus in patients with atrial fibrillation (AF) is lacking. The goal of the present study was to assess the association between plasma levels of HPA and LA/LAA thrombus in AF.

Methods

A total of 687 patients with nonvalvular AF (NVAF) without anticoagulation therapy were included from January 2016 to June 2019. Serum HPA analysis was performed with a commercially available human ELISA kit. Logistic regression models were used to test for association.

Results

Serum HPA levels were significantly higher in patients with LA/LAA thrombus than in those without LA/LAA thrombus (270.8 [193.4 ± 353.2] pg/mL vs 150.3 [125.2 ± 208.4] pg/mL; P < 0.001). In multivariate analysis, serum HPA remained a significantly independent predictor of LA/LAA thrombus (odds ratio 1.674, 95% confidence interval [CI] 1.339–2.289, P < 0.001). In the receiver operating characteristic (ROC) curve analysis, HPA showed a predictive value with an area under the curve (AUC) of 0.757 (95% CI 0.652–0.810, P < 0.001). The optimal cutoff level for HPA predicting LA/LAA thrombus was 210.7 pg/mL, with a sensitivity of 74.3% and a specificity of 64.8%.

Conclusion

An elevated HPA level was associated with the presence of LA/LAA thrombus in patients with AF. HPA might portend the risk for the prothrombotic state in AF patients.

Zusammenfassung

Hintergrund

Es fehlen Daten zur möglichen Rolle von Heparanase (HPA) beim Auftreten eines Thrombus linksatrial oder im linken Herzohr (LA/LAA) bei Patienten mit Vorhofflimmern (VF). Ziel der vorliegenden Studie war es, den Zusammenhang zwischen den Plasmaspiegel von HPA und einem LA/LAA-Thrombus bei VF zu untersuchen.

Methoden

Von Januar 2016 bis Juni 2019 wurden in die Studie 687 Patienten mit nichtvalvulärem VF (NVVF) ohne Antikoagulationstherapie einbezogen. Eine Serum-HPA-Analyse erfolgte mit einem kommerziell erhältlichen humanen ELISA-Kit. Logistische Regressionsmodelle wurden zur Prüfung des Zusammenhangs eingesetzt.

Ergebnisse

Die Serum-HPA-Spiegel waren bei Patienten mit LA/LAA-Thrombus signifikant höher als bei Patienten ohne LA/LAA-Thrombus (270,8 [193,4 ± 353,2] pg/ml vs. 150,3 [125,2 ± 208,4] pg/ml; p < 0,001). In der multivariaten Analyse blieb die Serum-HPA ein signifikant unabhängiger Prädiktor eines LA/LAA-Thrombus (Odds Ratio 1,674; 95 %-Konfidenzintervall, 95 %-KI: 1,339–2,289; p < 0,001). In der Receiver-Operating-Characteristic(ROC)-Kurvenanalyse zeigte sich für HPA ein prädiktiver Wert mit einem Areal unter der Kurve (AUC) von 0,757 (95 %-KI: 0,652–0,810; p < 0,001). Der optimale Grenzwert für HPA zur Vorhersage eines LA/LAA-Thrombus betrug 210,7 pg/ml, mit einer Sensitivität von 74,3 % und einer Spezifität von 64,8 %.

Schlussfolgerung

Ein erhöhter HPA-Spiegel ging mit dem Vorliegen eines LA/LAA-Thrombus bei Patienten mit VF einher. Der HPA-Wert könnte ein Hinweis auf das Risiko eines prothrombotischen Zustands bei VF-Patienten sein.

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Authors and Affiliations

  1. Siyami Ersek High Specialization Health Application and Research Center, Department of Cardiology, University of Health Sciences, Istanbul, Turkey

    Mehmet Fatih Yilmaz M.D & Can Yücel Karabay M.D

  2. Department of Cardiology, Gumushane State Hospital, Gumushane, Turkey

    Emrah Acar M.D

  3. Department of Cardiology, Bolu Abant Izzet Baysal University, Bolu, Turkey

    Mehmet Inanir M.D

  4. Kartal Kosuyolu High Specialization Health Application and Research Center, Department of Cardiology, University of Health Sciences, Istanbul, Turkey

    Ibrahim Akin Izgi M.D

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  1. Mehmet Fatih Yilmaz M.D
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Correspondence to Mehmet Fatih Yilmaz M.D.

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M. F. Yilmaz, E. Acar, M. Inanir, C. Y. Karabay and I. A. Izgi declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all participants included in the study.

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Yilmaz, M.F., Acar, E., Inanir, M. et al. Serum heparanase levels and left atrial/left atrial appendage thrombus in patients with nonvalvular atrial fibrillation. Herz 47, 251–257 (2022). https://doi.org/10.1007/s00059-021-05052-z

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