Embolic Stroke Diagnosed by Elevated D-Dimer in a Patient With Negative TEE for Cardioembolic Source

Sazonova, I.Y.; Pondicherry-Harish, Roja; Kadle, Nikhil; Sharma, Gyanendra K.; Figueroa, Ramón; Robinson, V.J.

doi:10.1177/2324709614560907

Cited by 3 publications

(2 citation statements)

References 24 publications

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“…In addition, Sun et al have found that the sensitivity of TEE for diagnosis of left atrial or LAA thrombus to be 93.3% (standard deviation: 90.5%-96.0%) 41. Additionally, this patient's D-dimer normalized only after three months, showing that the duration of elevation lags even after anticoagulation treatment is initiated 42. We had such a case within the cohort of our recruited patients, and a diagnosis of cardiac thromboembolism with recanalization thrombosis in the left middle cerebral artery was made based on MRA/MRI.…”

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confidence: 84%

Useful indices of thrombogenesis in the exclusion of intra‐cardiac thrombus

et al. 2019

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Abstract Background: Cardioversion in patients with atrial fibrillation (AF) can cause cardioembolic stroke, and effective clinical management is necessary to reduce morbidity and mortality. Currently, transesophageal echocardiography (TEE) is the accepted standard to diagnose cardiogenic thromboemboli; however, a negative TEE does not eliminate the possibility of left atrial thrombus. The objective of this study was to evaluate the diagnostic value of supplementing the TEE with additional noninvasive markers to ensure thrombus absence. Methods: A prospective study was conducted on 59 patients who underwent TEE for suspected intra-cardiac thrombi. The TEE indications included acute ischemic stroke (45.7%) and AF or flutter (59.3%). D-dimer level and white blood cell counts were assessed. Results: A negative D-dimer level (<200 ng/mL) excluded the presence of intra-cardiac thrombi. Groups with either negative (n = 14) or positive (n = 45) D-dimer levels had comparable clinical characteristics. Comparing positive D-dimer-level patients with thrombus (n = 7) and without thrombus (n = 33), patients with thrombus had reduced left atrial appendage (LAA) velocity (P = .0024), reduced left ventricular ejection fraction (LVEF) (P = .0263), increased neutrophil percent (P = .0261), decreased lymphocyte percent (P = .0216), and increased monocyte counts (P = .0220). The area under the receiver operating characteristic (ROC) curve for thrombus diagnostics was larger for combinations of clinical and biochemical data than for each parameter individually. Conclusions: Supplementing the gold standard TEE with the analysis of LAA velocity, noninvasive LVEF, D-dimer, and hemostatic markers provided additional useful diagnostic information. Larger studies are needed to further validate the efficacy of supplementing the TEE to better assess patients for intra-cardiac thrombi. K E Y W O R D S atrial fibrillation, cardiac thrombus, D-dimer assay, thrombosis, transesophageal echocardiography | 87 IBEBUOGU Et al.

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confidence: 84%

Useful indices of thrombogenesis in the exclusion of intra‐cardiac thrombus

et al. 2019

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“…Cardio-embolic stroke (CES) accounts for 20% of all ischemic strokes (IS) and is more restricting than non-embolic subtypes of stroke [3]. CES has the most unfavorable prognosis, being linked with an increased hazard of death or stroke recurrence [4].…”

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confidence: 99%

Cardio embolic stroke and blood biomarkers: diagnosis and predictors of short-term outcome

Mohamed

ElGawad

ELmotayam

et al. 2019

Egypt J Neurol Psychiatry Neurosurg

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Background: The brain is a productive source of a variety of enzymes and any brain injury like a stroke to brain tissue could similarly result in an increase in these enzymes in cerebrospinal fluid and serum. Evaluation of these enzymes represents a simple method for the ischemic stroke subtype diagnosis and prognosis. Objective: This study aimed to determine the role of brain natriuretic peptide (BNP), D-dimer, creatine-kinase-MB (CK-MB), C-reactive protein (CRP) serum levels, and globulin/albumin ratio in the diagnosis of CES stroke and its ability to predict short-term outcome. Methods: This study was conducted on 96 patients with acute ischemic stroke, subdivided into two groups: group Ι was 48 patients with cardio-embolic stroke and group ΙΙ was 48 patients with non-cardio-embolic. All patients were subjected to the assessment of serum BNP, D-dimer and CK-MB, and CRP and globulin/albumin ratio within the first 24 h of stroke. In the third week, they were assessed by mRS. Results: The mean levels of BNP, D-dimer level, and CK-MB were significantly higher in patients with cardio-embolic stroke than in patients with non-cardio-embolic stroke (P < 0.001) and also were associated with poor short-term outcome. Conclusion: Elevated plasma levels of BNP, D-dimer levels, and CK-MB can be used as surrogate biomarkers for the diagnosis of cardio-embolic stroke and prediction of poor short-term outcomes.

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How does atrial fibrillation cause development of atrial thrombosis and subsequent thromboembolism?

J.B. Robinson,

K. Sharma,

Sharma

et al. 2024

Atrial Fibrillation - Current Management and Practice [Working Title]

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Atrial fibrillation is the most common arrhythmia and carries a substantial risk for embolic stroke which can be significantly mitigated by anticoagulant therapy. In this chapter, we review the epidemiology of atrial fibrillation and the biologic antecedents leading to atrial fibrillation. We then comment on the interaction between atrial fibrillation and atrial cardiopathy. We will explore the question of whether atrial cardiopathy alone can produce embolic stroke. We hope the reader will then focus on the expanding surge of atrial fibrillation closely aligned with the increasing burden of embolic stroke. There are additional cardioembolic strokes that appear to occur in the presence of atrial cardiopathy without the onset of atrial fibrillation. Promising new markers are available for predicting atrial cardiopathy and hence guiding treatment for initiation of DOACs. This has the potential to prevent many embolic strokes before they occur. Another missed clinical opportunity is aggressively targeting diastolic dysfunction with ACE-I, AT2 blockers, and MRAs to prevent the development of advanced atrial cardiopathy and subsequent embolic stroke and atrial fibrillation.

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Embolic Stroke Diagnosed by Elevated D-Dimer in a Patient With Negative TEE for Cardioembolic Source

Cited by 3 publications

References 24 publications

Useful indices of thrombogenesis in the exclusion of intra‐cardiac thrombus

Useful indices of thrombogenesis in the exclusion of intra‐cardiac thrombus

Cardio embolic stroke and blood biomarkers: diagnosis and predictors of short-term outcome

How does atrial fibrillation cause development of atrial thrombosis and subsequent thromboembolism?

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