Predictive Value of D‐Dimer Levels and Tissue Doppler Mitral Annular Systolic Velocity for Detection of Left Atrial Appendage Thrombus in Patients with Mitral Stenosis in Sinus Rhythm

Kurakula, Naresh; Rajasekhar, D.; Vanajakshamma, V.; Akula, Vidya Sagar; Kasala, Latheef; Muvva, Kalyan Venkateswarlu

doi:10.1111/echo.13026

Cited by 6 publications

(10 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Characteristics of included studies are presented in Table 1 . All of the studies were observational studies, among which 8 studies [ 12 , 13 , 18 , 19 , 20 , 21 , 22 , 23 ] were prospective design. Mean age of study participants ranged from 29.7 to 76.0 years, and the percentage of males ranged from 28.4% to 77.8%.…”

Section: Resultsmentioning

confidence: 99%

“…Twelve (57.1%) studies confined the population to patients with AF [ 13 , 19 , 20 , 21 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 ], with reported percentages of patients with AF ranged from 20%-86% in 7 (33.3%) studies [ 12 , 18 , 22 , 32 , 33 , 34 , 35 ], besides, 2 (9.5%) studies focused on patients in sinus rhythm [ 23 , 36 ], 4 studies (19.0%) restricted to the population of patients with mitral stenosis [ 23 , 33 , 35 , 36 ], among which, 2 studies reported the prevalence of mitral stenosis ranged from 6.0% to 27.5% [ 28 , 37 ]. Of 21 included studies, 12 (57.1%) studies reported mean or median DD values [ 13 , 18 , 19 , 24 , 25 , 26 , 27 , 29 , 30 , 32 , 35 , 37 ], 5 (23.8%) studies reported frequency and DD cutoff value on LAT [ 22 , 23 , 31 , 33 , 34 ], and 4 (19.0%) studies reported both [ 12 , 20 , 21 , 36 ]. 11 studies have available information to calculate a ratio of the presence of LAT among individuals in the top vs bottom third of DD levels[ ...…”

Section: Resultsmentioning

confidence: 99%

“…Of 21 included studies, 12 (57.1%) studies reported mean or median DD values [ 13 , 18 , 19 , 24 , 25 , 26 , 27 , 29 , 30 , 32 , 35 , 37 ], 5 (23.8%) studies reported frequency and DD cutoff value on LAT [ 22 , 23 , 31 , 33 , 34 ], and 4 (19.0%) studies reported both [ 12 , 20 , 21 , 36 ]. 11 studies have available information to calculate a ratio of the presence of LAT among individuals in the top vs bottom third of DD levels[ 20 , 21 , 22 , 23 , 24 , 28 , 29 , 31 , 33 , 34 , 36 ].…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies [ 20 , 21 , 22 , 23 , 24 , 28 , 29 , 31 , 33 , 34 , 36 ] were included for estimating the association of DD on the presence of LAT. Of 1856 involved patients (weighted mean age of 60.3 years old), 238 patients have TEE identified LAT.…”

Section: Resultsmentioning

confidence: 99%

“…Of 1856 involved patients (weighted mean age of 60.3 years old), 238 patients have TEE identified LAT. Only 4 studies [ 20 , 21 , 23 , 24 ] made adjustments for potential confounders. The comparison of individuals with DD levels in the top third vs those in the bottom third yielded a combined risk ratio for the presence of LAT of 3.84 [95% CI: 2.35–6.28] (see Fig 6 .…”

Section: Resultsmentioning

confidence: 99%

See 4 more Smart Citations

Plasma fibrin D-dimer and the risk of left atrial thrombus: A systematic review and meta-analysis

Wan

Yang

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

BackgroundPlasma 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).MethodsWe 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.ResultsOf 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.ConclusionsHigh 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.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Plasma fibrin D-dimer and the risk of left atrial thrombus: A systematic review and meta-analysis

Wan

Yang

et al. 2017

PLoS ONE

View full text Add to dashboard Cite

show abstract

Implication of d-dimer in rheumatic severe mitral stenosis – A tertiary centre study

Sukulal

Nair

Sasidharan

et al. 2020

Indian Heart Journal

View full text Add to dashboard Cite

Background In rheumatic mitral stenosis (MS), left atrial (LA) thrombus and LA spontaneous echo contrast (LA SEC) reflect hypercoagulability. The study focuses on whether D-dimer levels predict the existence of LA thrombus and SEC in patients with severe MS. Methods 95 consecutive patients with severe MS referred for transesophageal echocardiogram (TEE) between July 2011 and March 2012 to evaluate LA thrombus prior to balloon mitral valvotomy (BMV) were included in the study. D-Dimer levels in these patients were observed. Results Out of the 95 patients, 15 (15.8%) had LA thrombus and 52 patients had LA SEC (54.7%). Any correlation between D-Dimer levels and existence (or non-existence) of LA thrombus was not noticed from the receiver operating characteristics (ROC) curve with an area of .535. For patients with LA SEC, the D-Dimer levels were found to be considerably higher (776 ± 866 μg/L vs. 294 ± 331 μg/L, p = .001). An ideal cut-off level of 393 μg/L for diagnosing LA SEC was illustrated by the ROC curve with a sensitivity of 63.4%, specificity of 83.72%, positive predictive value of 82.5% and a negative predictive value of 65.45%. Conclusions D-dimer levels were not representative of the presence or absence of LA thrombus in patients with severe MS. Nonetheless, this study demonstrated the substantial link between D-Dimer level and LA SEC. If a D-Dimer level of 400 μg/L or higher is taken as positive, it has high specificity and positive predictive value for diagnosing LA SEC.

show abstract

Evaluation of D-dimer levels in patients with prosthetic valve thrombosis

Çerşit

Gündüz

Bayam

et al. 2018

Blood Coagulation &Amp; Fibrinolysis

View full text Add to dashboard Cite

: Plasma D-dimer level is an indicator of thrombosis and endogenous fibrinolytic activity. We investigated the association between the D-dimer levels and thrombus burden and cerebrovascular events in patients with obstructive prosthetic valve thrombosis (PVT). This retrospective study included 47 patients with obstructive left-sided PVT and 32 controls in whom PVT was excluded with comprehensive transthoracic and transesophageal echocardiography (TEE). The patient group included 11 aortic, 27 mitral, and 9 aortic and mitral valve PVT patients and the control group included 2 aortic, 25 mitral, and 5 aortic and mitral valve patients. Laboratory analysis including plasma D-dimer levels was performed at the time of admission in all patients. The baseline characteristics were similar between the two groups. The plasma D-dimer levels were significantly higher in patients with obstructive PVT compared with controls [680 (110-3590) vs. 310 (80-380) μg/l; P < 0.001]. By multivariate logistic regression analysis high D-dimer level, low-INR value on admission, high NYHA functional class and recent history of cerebrovascular accident (CVA), and transient ischemic attack (TIA) were the independent predictors of obstructive PVT. A plasma D-dimer level of greater than 365 μg/l predicted the presence of PVT with a sensitivity of 81% and a specificity of 69% (AUC= 0.781, P < 0.001). Plasma D-dimer levels were significantly higher in patients with a recent history of CVA/TIA [2140 (470-2980) vs. 590 (380-830) μg/l; P = 0.021]. In addition to the so-called indicators of PVT including subtherapeutic anticoagulation, increased D-Dimer levels may strengthen the suspicion of PVT. Moreover, higher plasma D-dimer levels were associated with higher thrombus burden and higher prevalence of recent CVA/TIA.

show abstract

Predictive Value of D‐Dimer Levels and Tissue Doppler Mitral Annular Systolic Velocity for Detection of Left Atrial Appendage Thrombus in Patients with Mitral Stenosis in Sinus Rhythm

Abstract: Measurement of Sa and D-dimer levels is necessary for better assessment of LA thrombus and SEC, for identification of patients who are at high risk for LA thrombus formation and for initiation of prophylactic anticoagulation.

Cited by 6 publications

References 37 publications

Plasma fibrin D-dimer and the risk of left atrial thrombus: A systematic review and meta-analysis

Plasma fibrin D-dimer and the risk of left atrial thrombus: A systematic review and meta-analysis

Implication of d-dimer in rheumatic severe mitral stenosis – A tertiary centre study

Evaluation of D-dimer levels in patients with prosthetic valve thrombosis

Contact Info

Product

Resources

About