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European Heart Journal Advance Access published online on August 22, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm356
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Seiji Habara*, Keigo Dote, Masaya Kato, Shota Sasaki, Kenji Goto, Hiroaki Takemoto, Daiji Hasegawa and Osamu Matsuda

Department of Cardiology, Hiroshima City Asa Hospital, Hiroshima, Japan

Received 17 December 2006; revised 19 July 2007; accepted 26 July 2007.

* Corresponding author: Department of Cardiology, Kurashiki Central Hospital, 1-1-1 Miwa, kurashiki-shi, Okayama 710-8602, Japan. Tel: +81 86 422 0210; fax: +81 86 421 3424. E-mail address: sh10461{at}kchnet.or.jp

Aims: 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.

Methods and results: 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.

Conclusion: 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.

Key Words: Atrial fibrillation • Thrombus • Heart failure • Stroke


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