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Biomarkers for detection of a thrombus in the left atrial appendage: the search for the grail?
  1. Christoph R Sinning
  1. Department of Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany
  1. Correspondence to Dr Christoph R Sinning, General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg 20251, Germany; c.sinning{at}

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Patients with atrial fibrillation (AF) undergoing either pulmonary vein isolation (PVI) or direct current cardioversion (DCCV) most commonly undergo transoesophageal echocardiography (TOE) for definite exclusion of a thrombus in the left atrial appendage (LAA).1 As TOE as a semi-invasive procedure is not without risk to the patient and during the current times with a still ongoing SARS-Cov-2 pandemic for the clinician, a definite exclusion of LAA thrombosis before a PVI or DCCV using a readily available biomarker would minimise the risk for the patient and clinician alike. However, as far as now the quest to identify such a biomarker is still ongoing.

D-dimer levels in the ADDIT-AF Study and identification of patients with LAA thrombus

In their manuscript Almorad et al 2 did compare two cut-offs of D-dimer to exclude LAA thrombus before DCCV. In their study patients did receive a transthoracic echocardiography 6 months before the TOE and D-dimer levels were measured at the day of the DCCV. Two cut-offs were used in the study, the first being 500 ng/mL as suggested by the manufacturer of the test and the second being an age-adjusted value 10 times the patients age.2 The main finding was that both cut-offs were able to identify the 13 patients with LAA thrombus whereby the age-adjusted cut-off had a higher specificity with 66.4% to 50.4% for the standard …

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  • Contributors CRS is the sole author of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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