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


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.


CONCLUSIONS
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.
Habara
Seiji
S
Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan. sh10461@kchnet.or.jp
Dote
Keigo
K
Kato
Masaya
M
Sasaki
Shota
S
Goto
Kenji
K
Takemoto
Hiroaki
H
Hasegawa
Daiji
D
Matsuda
Osamu
O
D000368:Aged; D020517:Atrial Appendage; D001281:Atrial Fibrillation / Q000097:blood / Q000150:complications*; D015415:Biomarkers / Q000378:metabolism; D017548:Echocardiography, Transesophageal; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006333:Heart Failure / Q000097:blood / Q000150:complications*; D006801:Humans; D008297:Male; D018570:Risk Assessment; D020521:Stroke / Q000097:blood / Q000175:diagnosis; D013923:Thromboembolism / Q000175:diagnosis; D013927:Thrombosis / Q000175:diagnosis*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D