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

Almorad, Alexandre; Ohanyan, Anush; Pintea Bentea, Georgiana; Wielandts, Jean-Yves; El Haddad, Milad; Lycke, Michelle; O'Neill, Louisa; Morissens, Marielle; De Keyzer, Eva; Nguyen, Thomas; Anghel, Laura; Samyn, Sophie; Berdaoui, Brahim; Tavernier, Rene; Vandekerckhove, Yves; Duytschaever, Mattias; Verbeet, Thierry; Knecht, Sebastien; Castro Rodriguez, José

OBJECTIVE Left 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. METHODS 142 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. RESULTS LA 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