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D-dimer blood concentrations to exclude left atrial thrombus in patients with atrial fibrillation. | LitMetric

AI Article Synopsis

  • - The study investigates the effectiveness of two different D-dimer blood concentration cut-offs to exclude left atrial thrombus in patients with non-valvular atrial fibrillation (AF) before undergoing cardioversion: a fixed cut-off of 500 ng/mL and an age-adjusted cut-off based on the patient's age (10 times their age).
  • - In a cohort of 142 patients, transoesophageal echocardiography (TOE) confirmed LA thrombus was present in 9% of cases, with D-dimer levels significantly lower in those without thrombus, showcasing the potential for D-dimers to aid in diagnosis.
  • - The study concluded that using the age-adjusted D-dimer cut-off improves the

Article Abstract

Objective: Left atrial (LA) thrombus is routinely excluded by transoesophageal echocardiography (TOE) before cardioversion for non-valvular atrial fibrillation (AF). In the D-dimer blood concentrations to exclude LA thrombus in patients with AF study, two D-dimer cut-offs were compared to exclude LA thrombus prior to cardioversion. One was fixed to 500 ng/mL (DD500), based on clinical practice where such values are commonly accepted to exclude a thrombus. The other cut-off was adjusted to 10 times the patient's age (DDAge), based on the cut-off used to exclude pulmonary embolism.

Methods: 142 consecutive patients with non-valvular AF aged 69.7±11.4 years (52% with paroxysmal AF) referred for precardioversion TOE to exclude LA thrombus were prospectively enrolled. D-dimers were measured at the time of TOE by an ELISA test.

Results: LA thrombus was excluded with TOE in 129 (91%) and confirmed in 13 (9%) patients. D-dimers were significantly lower in patients without LA thrombus (729±611 vs 2376±1081 ng/L; p<0.05). DDAge indicated absence of LA thrombus with higher specificity than DD500 (66.4% vs 50.4%; p<0.05). Both cut-offs were able to identify all 13 patients with LA thrombus (false negative 0%). Patients with D-dimers
Conclusions: This study demonstrates the efficacy of D-dimer cut-offs to exclude LA thrombus in patients with AF. Age adjustment greatly increases the proportion of patients in whom LA thrombus can be safely excluded and consequently avoid precardioversion TOE.

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Source
http://dx.doi.org/10.1136/heartjnl-2020-317612DOI Listing

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