Comparison of immature platelet fraction (IPF) and factors associated with inflammation, thrombosis and platelet reactivity between patients with high versus low CHA2DS2-VASc without atrial fibrillation

Introduction

The CHA2DS2-VASc score was recently demonstrated to have a predictive value for systemic thromboembolism and mortality in patients with sinus rhythm and no history of atrial fibrillation, especially patients with heart failure or sick sinus syndrome. We compared factors of inflammation, thrombosis and platelet reactivity in patients with high and low CHA2DS2-VASc score in sinus rhythm.

Methods

We enrolled consecutive patients in sinus rhythm and with no history of atrial fibrillation. Blood samples were collected for neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP), immature platelet fraction (IPF) and count (IPC), CD 40 ligand, P-selectin and E-selectin. IPF was measured by an autoanalyzer; CD 40 ligand, P-selectin and E-selectin were measured by ELISA and NLR was calculated from complete blood count. Excluded were patients with anemia, thrombocytopenia, hemato-oncologic disease or acute coronary syndrome.

Results

A total of 108 patients were enrolled, mean age was 58±18y, 58% women, and 26% with diabetes. Of them 52 had high CHA2DS2-VASc score (>2 for male and >3 for female) and 56 had low CHA2DS2-VASc score. Patients with low CHA2DS2-VASc score were younger and had less comorbidities and smaller left atrial size than those with high score. P-selectin was higher in high versus low CHA2DS2-VASc score group (45 IQR 36-49 vs 37 IQR 28-46 ng/ml, p=0.041); inflammatory markers - CRP and NLR - were significantly elevated as well (3.1 IQR 1.7-9.3 vs 1.6 IQR 0.78-5.4 mg/L, p

Conclusion

Patients in sinus rhythm with high CHA2DS2-VASc score have higher inflammatory markers and soluble P-selectin levels compared to low score. These findings may explain the higher rate of adverse cardiovascular events in patients with sinus rhythm and an elevated CHA2DS2-VASC score.