High plasma fibrin D-dimer levels in the top third of the distribution were associated with a significantly increased risk of left atrial thrombus compared to the bottom third (RR 3.84).
Meta-Analysis (n=2,995)
Yes
Does plasma fibrin D-dimer level predict the presence of left atrial spontaneous echo contrast or left atrial thrombus in patients undergoing trans-esophageal echocardiography?
Elevated D-dimer levels are associated with the presence of left atrial thrombus and spontaneous echo contrast, offering moderate sensitivity and specificity as a potential non-invasive screening tool prior to transesophageal echocardiography.
Effect estimate: RR 3.84 (95% CI 2.35-6.28)
BACKGROUND: Plasma fibrin d-dimer has been taken as a marker for thrombus. The aim of this study was to evaluate the relationship between d-dimer (DD) levels and left atrial spontaneous echo contrast (SEC)/left atrial thrombus (LAT). METHODS: We identified clinical studies by systematic search of MEDLINE and EMBASE databases up to Feb 2016. All observational studies that considered DD as a study factor and trans-esophageal echocardiography (TEE) identified SEC/LAT as an outcome were included. Two reviewers independently selected the studies and extracted the data. RESULTS: Of the 21 included studies, 16 studies (2652 patients) have compared the mean DD differences between patients with and without an evidence of the presence of SEC/LAT, 9 studies (1667 patients) have estimated the diagnostic value of DD in the presence of LAT, and 11 studies (1856 patients) have available information to calculate a ratio of the presence of LAT among individuals in the top and the bottom third of DD levels. The pooled standardized mean difference (SMD) of DD between patients with and without left atrial SEC and/or LAT was 1.29 95%CI: 0.51, 2.08, with SMDs of 0.42 95% CI: 0.08, 0.77 and 2.34 95% CI: 1.01, 3.68 in SEC/LAT and LAT subgroups, respectively. The combined risk ratio of the presence of LAT among individuals between the top of the distribution of DD levels and that in the bottom third was 3.84 95% CI: 2.35, 6.28, associating with a mean difference of 0.78 ug/ml (1.10 vs 0.32 ug/ml). The pooled sensitivity, specificity and positive likelihood ratio of DD for LAT were 0.75 95% CI: 0.65, 0.83, 0.81 95% CI: 0.59, 0.93 and 4.0 95% CI: 1.7, 9.9, respectively. CONCLUSIONS: High plasma fibrin DD was associated with left atrial SEC/LAT, particularly among patients with LAT. DD levels have moderate sensitivity and specificity for diagnosing LAT.
Wan et al. (Thu,) conducted a meta-analysis in Left atrial thrombus (LAT) and spontaneous echo contrast (SEC) (n=2,995). High plasma fibrin D-dimer (top third of distribution) vs. Low plasma fibrin D-dimer (bottom third of distribution) was evaluated on Presence of left atrial thrombus (LAT) (RR 3.84, 95% CI 2.35-6.28). High plasma fibrin D-dimer levels in the top third of the distribution were associated with a significantly increased risk of left atrial thrombus compared to the bottom third (RR 3.84).