Differences in D-dimer blood concentration in atrial fibrillation patients with left atrial thrombus or severe left atrial spontaneous echo contrast

Lin, Changjian; Bao, Yangyang; Hua, Wei; Ning, Zengping; Qi, Jin; Xie, Yun; Yue, Wei; Liu, Zhuhui; Ling, Tianyou; Pan, Wei; Wu, Liqun

doi:10.1007/s10840-021-00991-3

Cited by 5 publications

(6 citation statements)

References 24 publications

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“…The use of oral anticoagulant drugs before D-dimer measurements increased the potential of normal range D-dimer levels in AF patients with LAT according to our results and previous paper. 18,19 Larger left atrial diameter was associated with increased D-dimer in AF patients with LAT in our study, which may be explained by D-dimer being a biomarker of degenerated fibrinogen during active thrombus formation, 20 which was more likely to be present and active in larger atria as shown in previous studies. 16,21 We found that the larger LAD was associated with increased D-dimer.…”

Section: Discussionsupporting

confidence: 77%

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Clinical Features Associated with ‘Normal Range’ Fibrin D-Dimer Levels in Atrial Fibrillation Patients with Left Atrial Thrombus

Bai

Luo

Liu

et al. 2022

Clin Appl Thromb Hemost

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Background Left atrial thrombus (LAT) often complicates with atrial fibrillation (AF). The evidence whether fibrin D-dimer levels could be used as a predictive biomarker for LAT is contradictory. This study firstly investigated the relationship between ‘normal range’ D-dimer and prevalent LAT. Second, we explored factors contributing to normal D-dimer levels in the presence of LAT. Methods We studied 244 AF patients with LAT (mean age: 59.9 years, SD:11.7; 53.3% female): of these, 103 (42.2%) had normal D-dimer, 25 (10.2%) had atrial thrombus exclusion score (ATE score) of 0 19 (16.7%) males had CHA2DS2-VASc score of 0, 21(16.2%) females had CHA2DS2-VASc score of 1 and 16 had overlapped ATE score of 0 and CHA2DS2-VASc score of 0 (N = 8 if male) or CHA2DS2-VASc score of 1(N = 8 if female). Using multivariate binary analysis, larger left atrial diameter (LAD; adjusted OR: 1.06, 1.03−1.10, p = 0.001) were associated with increased D-dimer. Patients with high body mass index (BMI), hypertension history and previous anticoagulation were more likely to show normal range D-dimer levels in the presence of LAT. Conclusions A high prevalence (42.2%) of ‘normal range’ D-dimer levels was found in AF patients with LAT, especially in those with hypertension, high BMI and prior anticoagulation. D-dimer levels of those patients with larger LAD were more likely to be increased.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Clinical Features Associated with ‘Normal Range’ Fibrin D-Dimer Levels in Atrial Fibrillation Patients with Left Atrial Thrombus

Bai

Luo

Liu

et al. 2022

Clin Appl Thromb Hemost

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“…Stroke risk was assessed by the CHA 2 DS 2 ‐VASc score, which is calculated by adding the risk factors of congestive heart failure, hypertension, age 65–74 years or ≥75 years, diabetes mellitus, stroke or TIA, vascular disease, and female sex. Each parameter was weighted by “1,” except for stroke or TIA and age ≥75 years, which were weighted by “2.” 8 …”

Section: Methodsmentioning

confidence: 99%

“…The mean ablation time was 99 8. ± 22.7 s. The minimum temperature T A B L E 1 Abbreviations: BMI, body mass index; DM, diabetes mellitus; EF, ejection fraction; LAD, left atrial diameter; LAV, left atrial volume; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; PAF, paroxysmal atrial fibrillation; TIA, transient ischemic attack.…”

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confidence: 99%

Initial experience of a novel method for electrical isolation of the superior vena cava using cryoballoon in patients with atrial fibrillation

Lin

Bao

Xie

et al. 2022

Clinical Cardiology

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Background Damage to the sinus node (SN) has been described as a potential complication of superior vena cava (SVC) isolation. There have been reports of permanent SN injury requiring pacemaker implantation during isolation of the SVC. Hypothesis It is safe and effective to isolate SVC with the second‐generation 28‐mm cryoballoon by using a novel method. Methods Forty‐three patients (including six redo cases) with SVC‐related atrial fibrillation (AF) from a consecutive series of 650 patients who underwent cryoballoon ablation were included. After pulmonary vein isolation was achieved, if the SVC trigger was identified, the SVC was electrically isolated using the cryoballoon. First, the cryoballoon was inflated in the right atrium (RA) and advanced towards the SVC‐RA junction. After total occlusion was confirmed by dye injection with total retention of contrast in the SVC, the SVC‐RA junction was determined. Next, the cryoballoon was deflated, advanced into SVC, then reinflated, and pulled back gently. The equatorial band of the cryoballoon was then set slightly (4.32 ± 0.71 mm) above the SVC‐RA junction for isolation of the SVC. Results Real‐time SVC potential was observed in all patients during ablation. The mean time to isolation was 24.5 ± 10.7 s. The SVC was successfully isolated in all patients. The mean number of freeze cycles was 2.5 ± 1.4 per patient, and the mean ablation time was 99.8 ± 22.7 s. A transient phrenic nerve (PN) injury occurred in one patient (2.33%). There were no SN injuries. Freedom from AF rates at 6 and 12 months was 97.7% and 93.0%, respectively. Conclusions This novel method for SVC isolation using the cryoballoon is safe and feasible when the SVC driver during AF is determined and could avoid SN injury. PN function should still be carefully monitored during an SVC isolation procedure.

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“…By comparing NVAF patients with and without SEC, previous studies have identified several risk factors for SEC presence, which are capable of reflecting hemodynamic and hematological status correlated with SEC formation, such as HF/decreased LVEF, LA dilation, increased fibrinogen, C-reactive protein, and D-dimer. 10,[29][30][31] Moreover, severe MR was reported to be protective against SEC owing to the increased shear rate within LA. However, it remained unclear if these parameters were suitable to predict severe SEC.…”

Section: La Hemodynamics and Severe Secmentioning

confidence: 99%

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

Wang

Chen

et al. 2022

Thromb Haemost

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Background Spontaneous echo contrast (SEC) is an important precursor for intracardiac thrombus and stroke. There is very limited data on characteristics of severe SEC and its impact on ischemic risk of NVAF patients after RFCA. Methods Transesophageal echocardiography files were reviewed between March 2009 and March 2021 in this monocentric retrospective study. SEC was classified into four levels. The primary endpoint was thromboembolic event (stroke, myocardial infarction, systemic embolism, and ensuing death), and the secondary endpoint included non-ischemic mortality and recurrent atrial arrhythmia. Results Six hundred SEC cases were enrolled and classified into mild SEC group (Grade 1-2, n=515) and severe SEC Group (Grade 3-4, n=85). Independent risk factors for severe SEC included higher brain natriuretic peptide (BNP), erythrocyte sedimentation rate (ESR), and LAd/∆LVED (LAd=left atrial diameter; ∆LVED= left ventricular end-diastolic diameter-left ventricular end-systolic diameter). Severe SEC group had a higher peri-procedure ischemic event occurrence. (7.1%vs. 1.9%, P=0.007). At a median follow-up of 55 months, severe SEC group had a lower freedom rate from ischemic events (90.1% vs. 75.3%, P<0.001); older age and severe SEC were independent risk factors for ischemic events. In patients undergoing redo-procedure (n=100), a remarkably reduced ESR (17.8±12.0 mm/h vs. 28.2±19.0 mm/h, P<0.001) was observed in patients whose SEC disappeared. Conclusions Higher BNP, ESR, LAd/∆LVED were the independent predictors for severe SEC. Severe SEC were associated with higher peri-procedural and long-term ischemic risks. ESR and LAd/∆LVED, as indicators of hematological and hemodynamic change, seemed helpful in identifying NVAF patients prone to developing severe SEC.

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Differences in D-dimer blood concentration in atrial fibrillation patients with left atrial thrombus or severe left atrial spontaneous echo contrast

Cited by 5 publications

References 24 publications

Clinical Features Associated with ‘Normal Range’ Fibrin D-Dimer Levels in Atrial Fibrillation Patients with Left Atrial Thrombus

Clinical Features Associated with ‘Normal Range’ Fibrin D-Dimer Levels in Atrial Fibrillation Patients with Left Atrial Thrombus

Initial experience of a novel method for electrical isolation of the superior vena cava using cryoballoon in patients with atrial fibrillation

Severe Left Atrial Spontaneous Echo Contrast in Nonvalvular Atrial Fibrillation: Clinical Characteristics and Impact on Ischemic Risk Postablation

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