Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation

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Abstract
There is little knowledge about the predictors of left atrial appendage (LAA) thrombi in non-valvular atrial fibrillation (NVAF). We investigated the ability of d-dimer to predict LAA thrombi. In this study, 925 patients with NVAF were enrolled. At the time of transoesophageal echocardiography (TEE), d-dimer levels were measured simultaneously. Significant independent predictors of LAA thrombi were the presence of congestive heart failure [odds ratio (OR) 3.10, 95% confidence interval (CI) 1.77–5.50, P < 0.0001), a history of recent embolic events (OR 3.39, 95% CI 1.90–6.04, P < 0.0001), and d-dimer levels (OR 97.6, 95% CI 17.3–595.8, P < 0.0001). Receiver operating characteristic analysis yielded an optimal cutoff value of 1.15 µg/mL for d-dimer to detect LAA thrombi. LAA thrombi were detected in 21.8% of patients with higher d-dimer values, whereas it was detected in only 3.1% of patients with lower d-dimer values. d-dimer cutoff level of 1.15 µg/mL had a negative predictive value of 97% for identifying LAA thrombi. In patients with NVAF, d-dimer may be helpful for predicting the absence of LAA thrombi. d-dimer level was clinically useful to guide the management of patients with NVAF, especially for those complicated with congestive heart failure and/or recent embolic events.

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