Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation

Eur Heart J. 2007 Sep;28(18):2217-22. doi: 10.1093/eurheartj/ehm356. Epub 2007 Aug 22.

Abstract

Aims: There is little knowledge about the predictors of left atrial appendage (LAA) thrombi in non-valvular atrial fibrillation (NVAF). We investigated the ability of D-dimer to predict LAA thrombi.

Methods and results: In this study, 925 patients with NVAF were enrolled. At the time of transoesophageal echocardiography (TEE), D-dimer levels were measured simultaneously. Significant independent predictors of LAA thrombi were the presence of congestive heart failure [odds ratio (OR) 3.10, 95% confidence interval (CI) 1.77-5.50, P < 0.0001), a history of recent embolic events (OR 3.39, 95% CI 1.90-6.04, P < 0.0001), and D-dimer levels (OR 97.6, 95% CI 17.3-595.8, P < 0.0001). Receiver operating characteristic analysis yielded an optimal cutoff value of 1.15 microg/mL for D-dimer to detect LAA thrombi. LAA thrombi were detected in 21.8% of patients with higher D-dimer values, whereas it was detected in only 3.1% of patients with lower D-dimer values. D-dimer cutoff level of 1.15 microg/mL had a negative predictive value of 97% for identifying LAA thrombi.

Conclusion: In patients with NVAF, D-dimer may be helpful for predicting the absence of LAA thrombi. D-dimer level was clinically useful to guide the management of patients with NVAF, especially for those complicated with congestive heart failure and/or recent embolic events.

MeSH terms

  • Aged
  • Atrial Appendage*
  • Atrial Fibrillation / blood
  • Atrial Fibrillation / complications*
  • Biomarkers / metabolism
  • Echocardiography, Transesophageal
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism*
  • Heart Failure / blood
  • Heart Failure / complications*
  • Humans
  • Male
  • Risk Assessment
  • Stroke / blood
  • Stroke / diagnosis
  • Thromboembolism / diagnosis
  • Thrombosis / diagnosis*

Substances

  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D