Factors associated with the presence of thrombus in the left atrial appendage and usefulness of the D-Dimer to rule out its presence

Abstract Introduction A transesophageal echocardiography (TEE) is recommended for non-anticoagulated patients with atrial fibrillation (AF) and >48 hours of evolution requiring electrical cardioversion (ECV) to rule out the presence thrombus in left appendage (LAA). It has been proposed that D-Dimer (DD) value useful its high sensitivity negative predictive (NPV). Purpose To evaluate prevalence LAA AF, factors associated diagnostic accuracy different DD cut-off points it out. Methods retrospective observational study which AF who underwent a TEE prior ECV were included consecutively. Results We 104 (85.6% admitted) between June 2020 February 2022. In 10 (9.6%) was evidenced LAA. The mean age 68.7±11 years 59.6% male. Most had hypertension (64.4%) 19.2% diabetes. Only 3.8% previous stroke. Concerning echocardiographic findings, (LA) volume 56.9±17ml/m2, LA diameter 49.2±6.4mm ventricular ejection fraction (LVEF) 47.5±17%. 12.5% CHADS2VASC2 scale ≤2. 69.2% not under antithrombotic therapy only 27% taken anticoagulant agents before (NOAC or antivitamin K). Neither score nor clinical evaluated significantly (Figure 1). 68 available (≤48 TEE) them 8 (11.7%) 12 (17%) ≤150ng/mL, 42 (61.7%) DD≤500ng/mL 48 (80%) DD≤10xAge. Figure 2 shows ROC curve DD: AUC 0.72 (CI 0.55–0.9). NPV 100% DD≤150 ng/mL (Sensibility (Se) 100%, Specificity (Sp) 20%), 92% DD≤500 (Se 62.5%, Sp 65%), 90% DD≤10xAge 37.5%, 80%). Conclusion similar previously described. sample size insufficient identify any factor thrombus. DD≤150ng/mL 100%. However, higher (500 10xAge) did allow their presence. Funding Acknowledgement Type funding sources: None.