The Relation Between Left Atrial Spontaneous Echo-Contrast (LASEC) and Homocysteine, Fibrinogen and D-Dimer Levels in Non-Valvular Atrial Fibrillation and Sinus Rythym

Homocysteine plays an important role for thrombotic process particularly in cerebrovascular and coronary occlusive diseases. Left atrial spontaneous echo-contrast is strongly associated with left atrial thrombi and posses a significant risk for cerebrovascular ischemic events. In this study, we investigated the relations between LASEC and homocysteine, fibrinogen and D-Dimer levels in non-valvular atrial fibrillation and normal sinus ryhtym. 78 patients with cerebrovascular ischemic event were included in this study.40 patients had atrial fibrillation while the remaining had normal sinus rythym. Following clinical data collection, plasma homocysteine , fibrinogen and D-Dimer levels were evaluated. Transesophageal echocardiography was performed to all patients to detect whether occlusive event has been associated with LASEC and left atrial thrombus or not. Homocysteine levels were found higher either in atrial fibrillation and normal sinus ryhtym group with left atrial spontaneous echo-contrast group compared to non-LASEC group. In LASEC with AF and NSR group homocysteine level was found to be higher than in the patients who has non-LASEC with AF and NSR ( LASEC AF vs non-LASEC AF ; p = 0.006, LASEC AF vs non-LASEC NSR ; p = 0.001, LASEC NSR vs non – LASEC AF ; p = 0.03 , LASEC NSR vs non-LASEC NSR ; p = 0.05 ). Elevated homocystein was also observed in patients with LA thrombus in LASEC AF and NSR group ( p = 0.001 ). There was no difference in fibrinogen and D-Dimer levels among groups. High Homocysteine levels were found to be strongly associated with left atrial blood stagnation and further cerebrovascular occlusive events. The findings- although there were some limitations- prop the thrombogenic activity of high homocysteine levels.