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

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.