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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
Author(s) -
Kurakula Naresh,
Durgaprasad Rajasekhar,
Velam Vanajakshamma,
Akula Vidya Sagar,
Kasala Latheef,
Muvva Kalyan Venkateswarlu
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13026
Subject(s) - thrombus , cardiology , medicine , sinus rhythm , stenosis , d dimer , mitral valve stenosis , atrial fibrillation
Background Transesophageal echocardiogram ( TEE ) is a gold standard test for diagnosis of left atrial ( LA ) thrombus, but it has limited sensitivity for identification of small thrombi within side lobes. Thus, the absence of visualizing a left atrial appendage ( LAA ) thrombus does not equate with the absence of a LAA thrombus. Aim To assess the predictive value of mitral annular systolic velocity (Sa) and D‐dimer for the detection of LA thrombus and spontaneous echocardiographic contrast ( SEC ) in mitral stenosis ( MS ) patients with sinus rhythm ( SR ). Methods Transthoracic echocardiogram, TEE , and D‐dimer analysis were performed in 104 severe MS patients and divided them into three groups: Group I:no LA thrombus or SEC ; Group II : LA SEC only; and Group III : LA thrombus. Results Group III had more severe New York Heart Association ( NYHA ) class ( III ‐ IV ) dyspnea and lower Sa (6.9 ± 0.7 vs.10.0 ± 1.2 cm/sec), lower LAA late emptying velocity (17.7 ± 2.1 vs. 24.4 ± 4.2 cm/sec), larger LA transverse dimension, and LAA area ( LAAA ) than group I+ II . Mean D‐dimer levels were higher in groups III and II than in group I. In multivariate analysis Sa, D‐dimer levels, LAAA , and NYHA class were independent predictors of LA thrombus. ROC curve analysis revealed that higher Sa >8 cm/sec and lower D‐dimer levels <370 μ g/L predict the absence of LA thrombus and lower Sa <8 cm/sec and higher D‐dimer levels >510 μ g/L predict the presence of LA thrombus. Conclusion 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.