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Differences in D-dimer blood concentration in atrial fibrillation patients with left atrial thrombus or severe left

Changjian Lin1, Yangyang Bao1, Wei Hua1

  • 1Department of Cardiology, Shanghai Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin Er Road, Shanghai, 200025, China.

Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing
|May 3, 2021
PubMed

Insights

In atrial fibrillation (AF) patients, lower D-dimer levels in severe left atrial spontaneous echo contrast (SLASEC) indicate a lower risk of left atrial thrombus (LAT) compared to those with LAT. D-dimer may predict LAT thrombolysis.

Area of Science:

  • Cardiology
  • Hematology
  • Diagnostic Imaging

Background:

  • Severe left atrial spontaneous echo contrast (SLASEC) is a precursor to left atrial thrombus (LAT) and a risk factor for thromboembolic events.
  • The role of D-dimer in excluding LAT in atrial fibrillation (AF) patients is suggested, but differences between SLASEC and LAT D-dimer levels are unclear.

Purpose of the Study:

  • To investigate whether D-dimer blood concentrations differ between AF patients with SLASEC and those with LAT.
  • To evaluate D-dimer as a potential marker for distinguishing pre-thrombotic states from established thrombi.

Main Methods:

  • Prospective study of nonvalvular AF patients undergoing TEE for SLASEC or LAT detection.
  • D-dimer concentrations and CHA2DS2-VASc scores were measured and evaluated.
  • Follow-up for thromboembolic complications in the SLASEC group.

Main Results:

  • AF patients with SLASEC had significantly lower D-dimer levels (0.26±0.13 mg/L) and CHA2DS2-VASc scores (2.3±0.9) compared to those with LAT (D-dimer: 0.86±0.9 mg/L, P<0.05; CHA2DS2-VASc: 3.1±1.5, P=0.02).
  • A D-dimer cut-off of 0.285 mg/L showed 77.3% sensitivity and 80.0% specificity for predicting LAT.
  • D-dimer levels decreased significantly after anticoagulation treatment in patients with resolved LAT (0.42±0.22 vs. 0.33±0.18 mg/L, P=0.03).
  • No thromboembolic events occurred in the SLASEC group during follow-up.

Conclusions:

  • Lower D-dimer concentrations and CHA2DS2-VASc scores are associated with SLASEC compared to LAT in AF patients.
  • A D-dimer cut-off of 0.285 mg/L can help differentiate between pre-thrombotic states and LAT.
  • D-dimer may serve as a predictive marker for LAT resolution through anticoagulation.
Abstract

Keywords:
Atrial fibrillationD-dimerLeft atrial spontaneous echo contrastThrombus

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