scholarly journals Diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Diaz-Arocutipa ◽  
A.C Gonzales-Luna ◽  
A Branez-Condorena ◽  
A.V Hernandez
Keyword(s):  
Atrial Fibrillation ◽  
Diagnostic Accuracy ◽  
Left Atrial ◽  
Meta Analysis ◽  
Characteristic Curve ◽  
Left Atrial Thrombus ◽  
Summary Receiver Operating Characteristic ◽  
Atrial Thrombus ◽  
Cross Sectional ◽  
D Dimer

Abstract Background There is limited evidence on the use of biomarkers to diagnose left atrial thrombus in atrial fibrillation. Purpose We evaluated the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation. Methods We searched four electronic databases from inception to December 16, 2020 for observational studies evaluating diagnostic accuracy of D-dimer. Reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the QUADAS-2 tool. We performed a bivariate random-effects meta-analysis to calculate the pooled sensitivity and specificity with their 95% confidence intervals (95% CI). In addition, a summary receiver operating characteristic curve and optimal cut-off were estimated. Results Eleven cross-sectional studies involving 4380 patients were included. The mean age ranged from 49.8 to 74.1 years and 70% of patients were men. Left atrial thrombus was present in 7% of cases. In seven studies, the pooled sensitivity of D-dimer at 500 ng/mL was 53% (95% CI, 26–79%) and the pooled specificity was 92% (95% CI, 80–97%). The pooled sensitivity of age-adjusted D-dimer was 35% (95% CI, 18–57%) and the pooled specificity was 100% (95% CI, 100–100%) in two studies. The optimal cut-off was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI, 44–85%) and a pooled specificity of 73% (95% CI, 54–86%). The risk of bias was low or unclear for all domains. Concerns regarding applicability were generally low for almost all studies Conclusion Our meta-analysis suggests that D-dimer has the potential to be useful to the detection of left atrial thrombus in patients with atrial fibrillation. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Predictors of left atrial thrombus in acute ischemic stroke patients without atrial fibrillation: A single-center cross-sectional study

2020 ◽  
Vol 66 (10) ◽  
pp. 1437-1443
Author(s):  
Tufan Cinar ◽  
Mert İlker Hayiroğlu ◽  
Vedat Çiçek ◽  
Süha Asal ◽  
Murat Mert Atmaca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Left Atrial ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Single Center ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Cross Sectional

SUMMARY INTRODUCTION: The present study aimed to determine independent predictors of left atrial thrombus (LAT) in acute ischemic stroke (AIS) patients without atrial fibrillation (AF) using transesophageal echocardiography (TEE). METHODS: In this single-center, retrospective study, we enrolled 149 consecutive AIS patients. All of the patients underwent a TEE examination to detect LAT within 10 days following admission. Multivariate logistic regression analysis was performed to assess independent predictors of LAT. RESULTS: Among all cases, 14 patients (9.3%) had a diagnosis of LAT based on the TEE examination. In a multivariate analysis, elevated mean platelet volume (MPV), low left-ventricle ejection fraction (EF), creatinine, and reduced left-atrium appendix (LAA) peak emptying velocity were independent predictors of LAT. The area under the receiver operating characteristic curve analysis for MPV was 0.70 (95%CI: 0.57-0.83; p = 0.011). With the optimal cut-off value of 9.45, MPV had a sensitivity of 71.4% and a specificity of 63% to predict LAT. CONCLUSION: AIS patients with low ventricle EF and elevated MPV should undergo further TEE examination to verify the possibility of a cardio-embolic source. In addition, this research may provide novel information with respect to the applicability of MPV to predict LAT in such patients without AF.

scholarly journals Evidence-Based Case Report: The Use of D-Dimer Assay to Exclude Left Atrial Thrombus in Patient with Atrial Fibrillation >48 Hours

2019 ◽  
Vol 11 (6) ◽  
Author(s):  
Raymond Pranata ◽  
Emir Yonas ◽  
Veresa Chintya ◽  
Alexander Edo Tondas ◽  
Sunu Budhi Raharjo
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Left Atrial ◽  
Evidence Based ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
D Dimer

scholarly journals CHA2DS2-VASc Score as a Predictor for Left Atrial Thrombus or Spontaneous Echo Contrast in Patients with Nonvalvular Atrial Fibrillation: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Ping Sun ◽  
Zhi Hao Guo ◽  
Hong Bin Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Publication Bias ◽  
Left Atrial ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Left Atrial Thrombus ◽  
Nonvalvular Atrial Fibrillation ◽  
Atrial Thrombus ◽  
Spontaneous Echo Contrast

Objective. This meta-analysis aimed at exploring the predictive value of CHA2DS2-VASc score for the left atrial thrombus (LAT) or left atrial spontaneous echo contrast (LASEC) in patients with nonvalvular atrial fibrillation (NVAF). Methods. PubMed, Embase, Web of Science, ScienceDirect, Cochrane Library, and Chinese core journals of the CNKI and Wanfang databases were searched to identify all the relevant papers that were published up to January 2020. The data were extracted for pooled odds ratios (ORs) with 95% confidence intervals (CIs), heterogeneity, subgroup, publication bias, and sensitivity analysis. Results. Overall, 15 studies containing 6223 patients with NVAF were enrolled. All studies were evaluated for LAT, and 12 studies were evaluated for LASEC. The pooled analysis using a random-effects model showed that a high CHA2DS2-VASc score was related with LAT/LASEC (pooled OR=1.59, 95% CI: 1.35–1.88, P<0.001) with high heterogeneity (I2=76.9%, P<0.001) and LAT (pooled OR=1.83, 95% CI: 1.44–2.33, P<0.001) with high heterogeneity (I2=79.4%, P<0.001). The subgroup analysis demonstrated that the sample size may be the main source of heterogeneity. Although the Begg’s funnel plot based on 15 studies for LAT/LASEC (P=0.029) and 12 studies for LAT (P=0.046) indicated the presence of publication bias among the included studies, the trim-and-fill method verified the stability of the pooled outcomes. In addition, sensitivity analysis indicated that all effects were stable. Conclusion. The results of this meta-analysis showed that the CHA2DS2-VASc score is related with LAT and LASEC in patients with NVAF. However, more studies are warranted to address this issue.

scholarly journals The Efficacy of Non–Vitamin K Antagonist Oral Anticoagulants in the Prevention of Left Atrial Thrombus in Patients With Atrial Fibrillation Compared With Vitamin K Antagonists: A Meta-Analysis

2020 ◽  
Vol 23 (6) ◽  
pp. E733-E739
Author(s):  
Jun Liu ◽  
Yiping Wu ◽  
Shurui Li ◽  
Lihong Song ◽  
Chengdong Hu
Keyword(s):  
Atrial Fibrillation ◽  
Vitamin K ◽  
Left Atrial ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Cochrane Library ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus

Background: There is still a paucity of data on the efficacy of non–vitamin K antagonist oral anticoagulants (NOACs) in the prevention of left atrial thrombus (LAT) formation before cardioversion or catheter ablation. To assess the efficacy of NOACs in the prevention of LAT in patients with non-valvular atrial fibrillation (NVAF) compared with vitamin K antagonists (VKAs), we conducted a meta-analysis. Methods: We searched PubMed, Embase, and the Cochrane Library databases. For meta-analysis, dichotomous variables were analyzed by using the odds ratios (OR) computed using the Mantel Haenszel method (random models). All results were reported with 95% confidence intervals (CI). Results: A total of 13 studies (one randomized controlled investigation and 12 observational studies) were included in the meta-analysis. There was no statistically significant difference between the NOACs and VKAs groups with respect to the odds of LAT/LAAT formations (OR 0.79; 95% CI: 0.52-1.21; P = .29; (I2 = 14%). Conclusions: NOACs were as effective as VKAs in the prevention of LAT/LAAT formation in patients with NVAF. Though patients on NOACs therapy showed a lower incidence of LAT/LAAT formation compared with VKAs, it was not significant (P = .29).

scholarly journals Plasma fibrin D-dimer and the risk of left atrial thrombus: A systematic review and meta-analysis

PLoS ONE ◽  
2017 ◽  
Vol 12 (2) ◽  
pp. e0172272 ◽  
Author(s):  
Huaibin Wan ◽  
Shuang Wu ◽  
Yanmin Yang ◽  
Jun Zhu ◽  
Aidong Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Left Atrial ◽  
Meta Analysis ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
D Dimer

D-dimer blood concentrations to exclude left atrial thrombus in patients with atrial fibrillation

Heart ◽  
2020 ◽  
pp. heartjnl-2020-317612
Author(s):  
Alexandre Almorad ◽  
Anush Ohanyan ◽  
Georgiana Pintea Bentea ◽  
Jean-yves Wielandts ◽  
Milad El Haddad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
False Negative ◽  
Transoesophageal Echocardiography ◽  
Elisa Test ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
True Negative ◽  
Blood Concentrations ◽  
D Dimer

ObjectiveLeft atrial (LA) thrombus is routinely excluded by transoesophageal echocardiography (TOE) before cardioversion for non-valvular atrial fibrillation (AF). In the D-dimer blood concentrations to exclude LA thrombus in patients with AF study, two D-dimer cut-offs were compared to exclude LA thrombus prior to cardioversion. One was fixed to 500 ng/mL (DD500), based on clinical practice where such values are commonly accepted to exclude a thrombus. The other cut-off was adjusted to 10 times the patient’s age (DDAge), based on the cut-off used to exclude pulmonary embolism.Methods142 consecutive patients with non-valvular AF aged 69.7±11.4 years (52% with paroxysmal AF) referred for precardioversion TOE to exclude LA thrombus were prospectively enrolled. D-dimers were measured at the time of TOE by an ELISA test.ResultsLA thrombus was excluded with TOE in 129 (91%) and confirmed in 13 (9%) patients. D-dimers were significantly lower in patients without LA thrombus (729±611 vs 2376±1081 ng/L; p<0.05). DDAge indicated absence of LA thrombus with higher specificity than DD500 (66.4% vs 50.4%; p<0.05). Both cut-offs were able to identify all 13 patients with LA thrombus (false negative 0%). Patients with D-dimers <DDAge and without LA thrombus (true negative) represented 60.6% of the population and could have safely avoided TOE (flow chart).ConclusionsThis study demonstrates the efficacy of D-dimer cut-offs to exclude LA thrombus in patients with AF. Age adjustment greatly increases the proportion of patients in whom LA thrombus can be safely excluded and consequently avoid precardioversion TOE.

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