Sugiura Shinya, Fujii Eitaro, Senga Michiharu, Sugiura Emiyo, Nakamura Mashio, Ito Masaaki
Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan.
J Interv Card Electrophysiol. 2012 Jun;34(1):59-63. doi: 10.1007/s10840-011-9633-6. Epub 2011 Dec 23.
Left atrial (LA) thrombus was sometimes found by transesophageal echocardiography (TEE) in non-valvular atrial fibrillation (AF), even in the setting of continuous warfarin therapy. A D-dimer cutoff level of 0.50 μg/mL appears to be a useful marker to rule out venous vein thrombosis. This study analyzed the clinical features of patients with LA thrombi who received anticoagulant therapy and whether the D-dimer test is useful to exclude LA thrombus.
Two hundred twenty-five consecutive patients with AF (149 with paroxysmal and 76 with persistent) were enrolled. All patients received continuous warfarin therapy with the prothrombin time-international normalized ratio (PT-INR) between 1.6 and 3.0 for more than 3 months and TEE was performed.
LA thrombi were present in 23 and absent in 202 patients. Age, gender, and PT-INR (1.96 ± 0.59 vs. 1.98 ± 0.53) were not different between the two groups. Persistent AF (65 vs. 30%; p < 0.005), LA diameter (44 ± 5 vs. 40 ± 7 mm; p < 0.005), ejection fraction (57 ± 13 vs. 65 ± 9%; p < 0.005), brain natriuretic peptide levels (203 ± 209 vs. 105 ± 166 pg/mL; p < 0.05), D-dimer (0.55 ± 0.70 vs. 0.16 ± 0.20 μg/mL; p < 0.001), LA appendage flow velocity (33 ± 15 vs. 54 ± 19 cm/s; p < 0.001), CHADS(2) scores (2 ± 1 vs. 1 ± 1; p < 0.005), and CHA(2)DS(2)-VASc scores (3 ± 2 vs. 2 ± 1; p < 0.005) were significantly different in both groups. Although multivariate analysis showed that D-dimer and LA appendage flow velocity were significant independent predictors of LA thrombus, D-dimer levels below 0.5 μg/mL were found in 19 of 23 patients with LA thrombi.
D-dimer levels below 0.5 μg/mL is not enough to rule out LA thrombus in AF patients with well-controlled anticoagulation.
经食管超声心动图（TEE）有时会在非瓣膜性心房颤动（AF）患者中发现左心房（LA）血栓，即便患者正在接受持续的华法林治疗。D - 二聚体临界值为0.50μg/mL似乎是排除静脉血栓形成的有用标志物。本研究分析了接受抗凝治疗的LA血栓患者的临床特征，以及D - 二聚体检测是否有助于排除LA血栓。
连续纳入225例AF患者（阵发性149例，持续性76例）。所有患者接受持续华法林治疗，凝血酶原时间 - 国际标准化比值（PT - INR）维持在1.6至3.0之间超过3个月，并进行TEE检查。
23例患者存在LA血栓，202例患者无LA血栓。两组患者的年龄、性别和PT - INR（1.96±0.59 vs. 1.98±0.53）无差异。持续性AF（65% vs. 30%；p < 0.005）、LA直径（44±5 vs. 40±7 mm；p < 0.005）、射血分数（57±13 vs. 65±9%；p < 0.005）、脑钠肽水平（203±209 vs. 105±166 pg/mL；p < 0.05）、D - 二聚体（0.55±0.70 vs. 0.16±0.20μg/mL；p < 0.001）、LA附件血流速度（33±15 vs. 54±19 cm/s；p < 0.001）、CHADS(2)评分（2±1 vs. 1±1；p < 0.005）和CHA(2)DS(2)-VASc评分（3±2 vs. 2±1；p < 0.005）在两组中均有显著差异。尽管多因素分析显示D - 二聚体和LA附件血流速度是LA血栓的重要独立预测因素，但23例LA血栓患者中有19例D - 二聚体水平低于0.5μg/mL。
对于抗凝控制良好的AF患者，D - 二聚体水平低于0.5μg/mL不足以排除LA血栓。
