The Value of D-Dimer Blood Concentrations in Prediction of Presence of Left Atrial Thrombus in Patients with non-valvular Atrial Fibrillation

Abstract

Background: Atrial fibrillation (AF) is the most typical sustained cardiac disturbance all over the world, it increases the risk of left atrial (LA) thrombus, Plasma fibrin D-dimers seems to be a helpful parameter for assessing the degrees of hypercoagulability. Higher risk of recurrent ischemic stroke was found to be associated with baseline elevated D-dimers levels. Aim: To assess the value of D-Dimer examination in prediction of presence of LA thrombus in patients with AF instead of transesophageal echocardiography (TEE) examination. Patients and Methods: Analytical cross-sectional study was conducted. It included 250 patients divided according to presence of LA thrombus into two groups; group without LA thrombus (n=224), and group with LA thrombus (n=26), referred to cardiology department, Mansoura Specialized Medicine Hospital. History was taken, blood was collected for D-dimer testing on the same day of the TEE. Results: CHADS2-VASc, Heart failure, Diastolic dysfunction, D-dimers (ng/mL), D Dimer more than 500 ng/mL, and D Dimer more than 10×patient’s age have positive and statistically significant impact on LA thrombus formation. Similarly, Paroxysmal AF and left ventricle ejection fraction (%) had negative and statistically significant impact on LA thrombus formation. The optimal cutoff point of D-dimers was 1247.9 (ng/mL), its accuracy was 86.4%, (AUC = 0.711) with sensitivity (50%) and specificity (90.6%). Conclusion: D-dimer can be beneficial in clinical practice to exclude LA thrombus avoiding TEE, particularly in patients with low thromboembolic risk such as normal left atrial dimensions, no previous attacks of AF, no valvular heart disease, female patient, CHAD2VASC score less than 2 and no history of thromboembolic attacks.