Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru; Programa de Atención Domiciliaria (PADOMI) - EsSalud, Lima, Peru; Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS), Lima, Peru.
Department of Cardiology, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru.
Heart Rhythm. 2021 Dec;18(12):2128-2136. doi: 10.1016/j.hrthm.2021.08.027. Epub 2021 Sep 1.
There is conflicting evidence about the use of biomarkers to diagnose left atrial thrombus in patients with atrial fibrillation.
The purpose of this study was to assess the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation.
We searched 4 electronic databases from inception to December 16, 2020. The reference standard was left atrial thrombus detected by transesophageal echocardiography. Study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies 2 tool. We used a bivariate model to calculate the pooled sensitivity and specificity with their 95% confidence intervals (CIs). The optimal cutoff and predictive values were also estimated.
Eleven cross-sectional studies involving 4380 patients were included. The median prevalence of left atrial thrombus was 12%. In 7 studies, the pooled sensitivity of D-dimer at 500 ng/mL was 50% (95% CI 26%-74%) and the pooled specificity was 88% (95% CI 76%-95%). The pooled sensitivity of age-adjusted D-dimer was 36% (95% CI 14%-66%) and the pooled specificity was 99% (95% CI 96%-99%) in 2 studies. The optimal cutoff of D-dimer was 390 ng/mL in 10 studies with a pooled sensitivity of 68% (95% CI 44%-85%) and a pooled specificity of 73% (95% CI 54%-86%). The positive and negative predictive values were 21.8% and 95.4%, respectively. The risk of bias was low or unclear for all domains. Concerns about applicability were low for almost all studies.
Our meta-analysis suggests that D-dimer has the potential to be useful to rule out left atrial thrombus in patients with atrial fibrillation.
关于生物标志物在房颤患者中诊断左心房血栓的应用存在相互矛盾的证据。
本研究旨在评估 D-二聚体诊断房颤患者左心房血栓的诊断准确性。
我们从建库至 2020 年 12 月 16 日检索了 4 个电子数据库。参考标准是经食管超声心动图检测到的左心房血栓。使用 QUADAS-2 工具评估研究质量。我们使用双变量模型计算合并的敏感性和特异性及其 95%置信区间（CI）。还估计了最佳截断值和预测值。
共纳入 11 项横断面研究，涉及 4380 例患者。左心房血栓的中位患病率为 12%。在 7 项研究中，D-二聚体在 500ng/mL 时的合并敏感性为 50%（95%CI 26%-74%），特异性为 88%（95%CI 76%-95%）。在 2 项研究中，年龄校正的 D-二聚体的合并敏感性为 36%（95%CI 14%-66%），特异性为 99%（95%CI 96%-99%）。在 10 项研究中，D-二聚体的最佳截断值为 390ng/mL，合并敏感性为 68%（95%CI 44%-85%），特异性为 73%（95%CI 54%-86%）。阳性和阴性预测值分别为 21.8%和 95.4%。所有领域的偏倚风险均较低或不明确。几乎所有研究的适用性问题均较低。
本荟萃分析表明，D-二聚体有可能有助于排除房颤患者的左心房血栓。
Zotero 插件