Key result
Adding CRP or D-dimer to normal sinus rhythm and normal ejection fraction yielded a 100% negative predictive value for the absence of intra-cardiac thrombus or spontaneous echo contrast.
Why the study?
Does the measurement of high sensitivity CRP and D-dimer combined with normal ejection fraction and sinus rhythm predict the absence of intracardiac thrombus and spontaneous echo contrast in patients referred for transesophageal echocardiography?
Observational (n=124)
Does the measurement of high sensitivity CRP and D-dimer combined with normal ejection fraction and sinus rhythm predict the absence of intracardiac thrombus and spontaneous echo contrast in patients referred for transesophageal echocardiography?
Effect estimate: NPV 100%
The presence of normal sinus rhythm and normal ejection fraction, especially when combined with normal CRP or D-dimer, has a very high negative predictive value for intracardiac thrombus, potentially deferring the need for TEE.
May aid risk stratification for ICT/SEC absence in TEE referrals; leaves open need for prospective validation before practice change.
BACKGROUND: Intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) are considered hypercoagulable and inflammatory conditions. We aimed to determine if high sensitivity C-reactive protein (CRP) and D-dimer (DD), in combination with variables of lower thrombotic risk (normal ejection fraction [NEF], sinus rhythm [NSR]), may predict the absence of ICT/SEC. METHODS AND RESULTS: Consecutive patients referred for transesophageal echocardiogram (TEE) for evaluation of cardioembolic source were prospectively enrolled. CRP and DD levels were determined at the time of TEE. 124 patients were enrolled, of whom 21 had ICT/SEC. The combination of NSR/NEF had a negative predictive value (NPV) of 98.6% for absence of ICT/SEC. The NPVs of CRP and DD were 93.6% and 85%, respectively. Adding either CRP or DD to NSR/NEF combination increased the NPV to 100%. Log CRP was significantly associated with ICT/SEC. CONCLUSIONS: The presence of NSR and NEF may defer the need for TEE for ICT/SEC evaluation. CRP association with ICT/SEC suggests that inflammation plays a role in ICT/SEC formation. Whether CRP and DD should become routine in the triage process of TEE for ICT/SEC evaluation requires further large scale prospective studies.
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Abu‐Mahfouz et al. (2012) conducted an observational in Evaluation of cardioembolic source (n=124). High sensitivity C-reactive protein (CRP) and D-dimer (DD) combined with normal ejection fraction and sinus rhythm was evaluated on Absence of intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) (NPV 100%). Adding CRP or D-dimer to normal sinus rhythm and normal ejection fraction yielded a 100% negative predictive value for the absence of intra-cardiac thrombus or spontaneous echo contrast.
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