title: Predictive Value of D-Dimer Levels and Tissue Doppler Mitral Annular Systolic Velocity for Detection of Left Atrial Appendage Thrombus in Patients with Mitral Stenosis in Sinus Rhythm.
abstract: BACKGROUND
  Transesophageal echocardiogram (TEE) is a gold standard test for diagnosis of left atrial (LA) thrombus, but it has limited sensitivity for identification of small thrombi within side lobes. Thus, the absence of visualizing a left atrial appendage (LAA) thrombus does not equate with the absence of a LAA thrombus.
  
  
  OBJECTIVE
  To assess the predictive value of mitral annular systolic velocity (Sa) and D-dimer for the detection of LA thrombus and spontaneous echocardiographic contrast (SEC) in mitral stenosis (MS) patients with sinus rhythm (SR).
  
  
  METHODS
  Transthoracic echocardiogram, TEE, and D-dimer analysis were performed in 104 severe MS patients and divided them into three groups: Group I:no LA thrombus or SEC; Group II:LA SEC only; and Group III:LA thrombus.
  
  
  RESULTS
  Group III had more severe New York Heart Association (NYHA) class (III-IV) dyspnea and lower Sa (6.9 ± 0.7 vs.10.0 ± 1.2 cm/sec), lower LAA late emptying velocity (17.7 ± 2.1 vs. 24.4 ± 4.2 cm/sec), larger LA transverse dimension, and LAA area (LAAA) than group I+II. Mean D-dimer levels were higher in groups III and II than in group I. In multivariate analysis Sa, D-dimer levels, LAAA, and NYHA class were independent predictors of LA thrombus. ROC curve analysis revealed that higher Sa >8 cm/sec and lower D-dimer levels <370 μg/L predict the absence of LA thrombus and lower Sa <8 cm/sec and higher D-dimer levels >510 μg/L predict the presence of LA thrombus.
  
  
  CONCLUSIONS
  Measurement of Sa and D-dimer levels is necessary for better assessment of LA thrombus and SEC, for identification of patients who are at high risk for LA thrombus formation and for initiation of prophylactic anticoagulation.
authors.affiliation: Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Kurakula
authors.affiliation: Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
authors.forename: Rajasekhar
authors.initials: R
authors.lastname: Durgaprasad
authors.affiliation: Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
authors.forename: Vanajakshamma
authors.initials: V
authors.lastname: Velam
authors.affiliation: Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
authors.forename: Vidya Sagar
authors.initials: VS
authors.lastname: Akula
authors.affiliation: Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
authors.forename: Latheef
authors.initials: L
authors.lastname: Kasala
authors.affiliation: Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India.
authors.forename: Kalyan Venkateswarlu
authors.initials: KV
authors.lastname: Muvva
mesh_terms: D000328:Adult; D020517:Atrial Appendage / Q000000981:diagnostic imaging*; D003328:Coronary Thrombosis / Q000150:complications / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000000981:diagnostic imaging*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D013599:Systole
keywords: D-dimer; left atrial appendage thrombus; mitral annular systolic velocity