title: Asymmetric dimethylarginine predicts left atrial appendage thrombus in patients with non-valvular atrial fibrillation.
abstract: BACKGROUND
  Atrial fibrillation (AF) is associated with increased thrombo-embolic events, with thrombi most frequently located in the left atrial appendage (LAA). Asymmetric dimethylarginine (ADMA), a potent endogenous inhibitor of nitric oxide synthase, is elevated in subjects with AF. We investigated the relationship between ADMA and risk of LAA thrombus in patients with non-valvular AF.
  
  
  RESULTS
  A total of 223 consecutive patients with non-valvular AF were enrolled (63 ± 10 years, 65% male). LAA thrombus was detected in 27 subjects by transesophageal echocardiography. Serum ADMA was significantly increased (2.5 ± 0.6 μmol/L vs 1.8 ± 0.4 μmol/L, p<0.001), while serum nitrite/nitrate was significantly reduced in patients with LAA thrombus (30.3 ± 7.1 μmol/L vs 48.4 ± 9.3 μmol/L, p<0.001). ADMA was positively correlated with age and left atrium diameter, and was negatively correlated with nitrite/nitrate and LAA peak flow velocity. The area under the receiver operating characteristic curve of ADMA predicting thrombus was 0.84. In multivariate logistic regression analysis, ADMA (OR 4.0, 95% CI 1.2-13.0; p=0.003) was one of independent risk factors for LAA thrombus.
  
  
  CONCLUSIONS
  Our study suggested that high ADMA was independently associated with the presence of LAA thrombus in patients with non-valvular AF.
authors.affiliation: Department of Cardiology, Qingdao Municipal Hospital, Shandong Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xia
authors.affiliation: Department of Cardiology, Qingdao Municipal Hospital, Shandong Province, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Ultrasonography, Qingdao Fuwai Cardiovascular Hospital, Shandong Province, China.
authors.forename: Tongqing
authors.initials: T
authors.lastname: Duan
authors.affiliation: Department of Gerontology, Qingdao Municipal Hospital, Shandong Province, China.
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Rong
authors.affiliation: Department of Cardiology, Qingdao Municipal Hospital, Shandong Province, China.
authors.forename: Yifan
authors.initials: Y
authors.lastname: Chi
authors.affiliation: Department of Cardiology, Qingdao Municipal Hospital, Shandong Province, China. Electronic address: summer0419163@163.com.
authors.forename: Yibing
authors.initials: Y
authors.lastname: Shao
mesh_terms: D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000096:biosynthesis; D013927:Thrombosis / Q000097:blood / Q000209:etiology*
chemical_list: D009569:Nitric Oxide; C018524:N,N-dimethylarginine; D001120:Arginine
keywords: Asymmetric dimethylarginine; Atrial fibrillation; Left atrial appendage; Thrombus