title: D-Dimer assay as a non invasive test for the diagnosis of left atrial Thrombi in Indian patients with Rheumatic MS.
abstract: BACKGROUND
  Systemic embolism is a serious and sometime fatal complication of rheumatic MS.
  
  
  OBJECTIVE
  We assessed the predictive power of D-Dimer level to predict occurrence of left atrial (LA) thrombi in patients with rheumatic mitral stenosis (MS).
  
  
  METHODS
  D-dimer levels were analyzed for 24 patients with rheumatic MS with LA clot and 22 patients with rheumatic MS with no LA clot undergoing transeosophageal echocardiography. A level more than 4 µg/ml was taken as elevated to predict the presence of LA clot in the study groups.
  
  
  RESULTS
  For a cut-off value of 4 µg/ml, sensitivity was 66.67 % and specificity 100 % for prediction of LA clot and AUC 0.710. A cut-off value of less than 1 µg/ml, sensitivity was 91.67 % and 87. 5 % negative predictive value for ruling out presence of LA clot and AUC 0.721.
  
  
  CONCLUSIONS
  A higher value of D-dimer can predict the possible presence of a LA clot and very low value can predict absence of clot in patients with rheumatic MS.
authors.affiliation: Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
authors.forename: M
authors.initials: M
authors.lastname: Rajappa
authors.affiliation: Department of Cardiology, Belhoul Speciality Hospital, Dubai, United Arab Emirates.
authors.forename: T N
authors.initials: TN
authors.lastname: Sunil Roy
authors.affiliation: Department of Cardiology, G.B. Pant Hospital, New Delhi, India.
authors.forename: A
authors.initials: A
authors.lastname: Raj
authors.affiliation: Department of Cardiology, G.B. Pant Hospital, New Delhi, India.
authors.forename: V
authors.initials: V
authors.lastname: Trehan
authors.affiliation: Department of Biochemistry, G.B. Pant Hospital, New Delhi, India.
authors.forename: V
authors.initials: V
authors.lastname: Mallika
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006325:Heart Atria; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000175:diagnosis*; D012214:Rheumatic Heart Disease / Q000150:complications*; D013927:Thrombosis / Q000175:diagnosis*; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: D-Dimer levels; Left atrial thrombus; Rheumatic MS; Transoesophageal echocardiography