The Value of D-Dimer Blood Concentrations in Prediction of Presence of Left Atrial Thrombus in Patients with non-valvular Atrial Fibrillation

Background: Atrial fibrillation (AF) is the most typical sustained cardiac disturbance all over the world, it increases the risk of left atrial (LA) thrombus, Plasma fibrin D-dimers seems to be a helpful parameter for assessing the degrees of hypercoagulability. Higher risk of recurrent ischemic stroke was found to be associated with baseline elevated D-dimers levels. Aim: To assess the value of D-Dimer examination in prediction of presence of LA thrombus in patients with AF instead of transesophageal echocardiography (TEE) examination. Patients and Methods: Analytical cross-sectional study was conducted. It included 250 patients divided according to presence of LA thrombus into two groups; group without LA thrombus (n=224), and group with LA thrombus (n=26), referred to cardiology department, Mansoura Specialized Medicine Hospital. History was taken, blood was collected for D-dimer testing on the same day of the TEE. Results: CHADS2-VASc, Heart failure, Diastolic dysfunction, D-dimers (ng/mL), D Dimer more than 500 ng/mL, and D Dimer more than 10×patient’s age have positive and statistically significant impact on LA thrombus formation. Similarly, Paroxysmal AF and left ventricle ejection fraction (%) had negative and statistically significant impact on LA thrombus formation. The optimal cutoff point of D-dimers was 1247.9 (ng/mL), its accuracy was 86.4%, (AUC = 0.711) with sensitivity (50%) and specificity (90.6%). Conclusion: D-dimer can be beneficial in clinical practice to exclude LA thrombus avoiding TEE, particularly in patients with low thromboembolic risk.