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

Abstract

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.

Low-density lipoprotein cholesterol-to-lymphocyte count ratio (LLR) is a promising novel predictor of postoperative new-onset deep vein thrombosis following open wedge high tibial osteotomy: a propensity score-matched analysis

“…On the other hand, reduced lymphocyte counts are an independent risk factor for poor prognosis in many diseases [ 32 – 35 ]. A prospective study by Ibebuogu et al found that peripheral blood lymphocyte levels were significantly lower in patients with D-dimer-positive thrombosis compared to those without thrombosis [ 20 ], suggesting a potential negative correlation between lymphocyte count levels and thrombosis. Firstly, reduced peripheral blood lymphocyte levels can cause immunosuppression and impaired regulation of the inflammatory response, leading to excessive or insufficient inflammatory response and promoting thrombosis [ 36 ].…”

“…For example, in patients with early-stage breast cancer, high LDL-C (> 3.6 mmol/L) increased the risk of catheter-related venous thrombosis by 2.36-fold [ 19 ]. On the other hand, lymphocytes play an important role in immunity and oxidative stress, and Ibebuogu et al have found a significant correlation between decreased lymphocyte levels and intracardiac thrombosis in atrial fibrillation [ 20 ]. However, it is inappropriate to extrapolate the above findings in patients with malignancy or cardiovascular disease to postoperative new-onset DVT in orthopedic or even OWHTO patients.…”

Prediction of Left and Right Atrials Appendage Thrombosis in Patient with Non-Valvular Atrial Fibrillation

“…Дисфункция ЛЖ является независимым фактором риска развития тромбоза уЛП на фоне ФП, что подтверждено во многих исследованиях [52,53,77,78,90]. Степень дисфункции ЛЖ прямо влияет на повышение внутрипредсердного давления и ремоделирование ЛП [91].…”

Management of cerebral amyloid angiopathy and atrial fibrillation: We are still far from precision medicine

“…Most of the thromboembolism in AF that causes ischemic stroke originates from the LAA[ 69 , 70 ]. Closure of the LAA represents a safe and effective strategy for stroke prevention, targeting patients with high bleeding risk[ 12 ], and a few clinical data support some devices for percutaneous LAAC.…”