PT  - JOURNAL ARTICLE
AU  - Alexandre Almorad
AU  - Anush Ohanyan
AU  - Georgiana Pintea Bentea
AU  - Jean-yves Wielandts
AU  - Milad El Haddad
AU  - Michelle Lycke
AU  - Louisa O’Neill
AU  - Marielle Morissens
AU  - Eva De Keyzer
AU  - Thomas Nguyen
AU  - Laura Anghel
AU  - Sophie Samyn
AU  - Brahim Berdaoui
AU  - Rene Tavernier
AU  - Yves Vandekerckhove
AU  - Mattias Duytschaever
AU  - Thierry Verbeet
AU  - Sebastien Knecht
AU  - José Castro Rodriguez
TI  - D-dimer blood concentrations to exclude left atrial thrombus in patients with atrial fibrillation
AID  - 10.1136/heartjnl-2020-317612
DP  - 2021 Feb 01
TA  - Heart
PG  - 195--200
VI  - 107
IP  - 3
4099  - http://heart.bmj.com/content/107/3/195.short
4100  - http://heart.bmj.com/content/107/3/195.full
SO  - Heart2021 Feb 01; 107
AB  - Objective Left atrial (LA) thrombus is routinely excluded by transoesophageal echocardiography (TOE) before cardioversion for non-valvular atrial fibrillation (AF). In the D-dimer blood concentrations to exclude LA thrombus in patients with AF study, two D-dimer cut-offs were compared to exclude LA thrombus prior to cardioversion. One was fixed to 500 ng/mL (DD500), based on clinical practice where such values are commonly accepted to exclude a thrombus. The other cut-off was adjusted to 10 times the patient’s age (DDAge), based on the cut-off used to exclude pulmonary embolism.Methods 142 consecutive patients with non-valvular AF aged 69.7±11.4 years (52% with paroxysmal AF) referred for precardioversion TOE to exclude LA thrombus were prospectively enrolled. D-dimers were measured at the time of TOE by an ELISA test.Results LA thrombus was excluded with TOE in 129 (91%) and confirmed in 13 (9%) patients. D-dimers were significantly lower in patients without LA thrombus (729±611 vs 2376±1081 ng/L; p<0.05). DDAge indicated absence of LA thrombus with higher specificity than DD500 (66.4% vs 50.4%; p<0.05). Both cut-offs were able to identify all 13 patients with LA thrombus (false negative 0%). Patients with D-dimers <DDAge and without LA thrombus (true negative) represented 60.6% of the population and could have safely avoided TOE (flow chart).Conclusions This study demonstrates the efficacy of D-dimer cut-offs to exclude LA thrombus in patients with AF. Age adjustment greatly increases the proportion of patients in whom LA thrombus can be safely excluded and consequently avoid precardioversion TOE.