Implication of d-dimer in rheumatic severe mitral stenosis - A tertiary centre study

Area of Science:

• Cardiology
• Hematology
• Diagnostic Imaging

Background:

• Rheumatic mitral stenosis (MS) is associated with hypercoagulability, indicated by left atrial (LA) thrombus and LA spontaneous echo contrast (LA SEC).
• Predictive markers for these conditions in severe MS are crucial for patient management.

Purpose of the Study:

• To investigate whether D-dimer levels can predict the presence of LA thrombus and LA SEC in patients with severe MS.
• To assess the diagnostic utility of D-dimer levels for LA SEC.

Main Methods:

• A cohort of 95 consecutive patients with severe MS undergoing transesophageal echocardiogram (TEE) for pre-procedural evaluation were included.
• D-dimer levels were measured and analyzed in relation to the presence of LA thrombus and LA SEC.

Main Results:

• No significant correlation was found between D-dimer levels and the presence of LA thrombus (ROC AUC = 0.535).
• Patients with LA SEC exhibited significantly higher D-dimer levels (776 ± 866 μg/L) compared to those without (294 ± 331 μg/L, p=0.001).
• A D-dimer cut-off of 393 μg/L demonstrated good diagnostic performance for LA SEC (sensitivity 63.4%, specificity 83.72%).

Conclusions:

• D-dimer levels are not predictive of LA thrombus in severe MS.
• Elevated D-dimer levels are substantially linked to LA SEC, with a level of ≥400 μg/L showing high specificity and positive predictive value for its diagnosis.