Department of Cardiology, Jiangbin Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Department of Cardiology, Liuzhou People's Hospital, Liuzhou, Guangxi, China.
Sci Rep. 2023 Oct 23;13(1):18075. doi: 10.1038/s41598-023-45077-4.
D-dimer is a biomarker of coagulation and fibrinolytic system activation in response to the body's hypercoagulable state. The study aims to investigate the usefulness of D-dimer in diagnosing and assessing the risk of intracardiac thrombus in patients with dilated cardiomyopathy (DCM). Consecutively enrolled in this study were patients with DCM who were admitted to our center for the first time. The diagnostic value was evaluated using the receiver operating characteristic (ROC) curve. Additionally, we used univariate and multivariate logistic regression to investigate the association between D-dimer and intracardiac thrombus. We also performed smooth curve fitting, threshold saturation effect analysis, and subgroup analysis. In total, 534 patients were enrolled in the study, and among them, 65 patients had intracardiac thrombus. Mural thrombus was the predominant type of thrombus, which was mainly located in the left ventricular apex. The optimal cut-off value of D-dimer for the diagnosis of intracardiac thrombus was 484 ng/mL, with a sensitivity and specificity of 0.769 and 0.646, respectively. In both unadjusted and adjusted logistic regression models, a positive association was found between D-dimer and intracardiac thrombus. Curve fitting and threshold effect analysis revealed two inflection points in the relationship between D-dimer and intracardiac thrombus (non-linear test: P = 0.032). When D-dimer was equal to 362 ng/mL, the odds ratio (OR) was 1, and the risk of thrombus gradually increased until it reached 4096 ng/mL, after which the trend no longer increased. Within this range, a twofold increase in D-dimer was associated with a 103.2% increased risk (OR = 2.032; 95% CI 1.293-3.193; P < 0.01). In the subgroup analysis, there was a significant interaction between D-dimer and BMI on intracardiac thrombus (P value for interaction was 0.013), and the risk was higher in patients with a BMI ≥ 25 kg/m (OR = 3.44; 95% CI 1.86-6.36; P < 0.01).
D-二聚体是一种凝血和纤维蛋白溶解系统激活的生物标志物，对机体的高凝状态有反应。本研究旨在探讨 D-二聚体在诊断和评估扩张型心肌病（DCM）患者心腔内血栓风险中的作用。本研究连续纳入首次入住我院的 DCM 患者。采用受试者工作特征（ROC）曲线评估诊断价值。此外，我们还使用单因素和多因素逻辑回归分析探讨 D-二聚体与心腔内血栓的关系。我们还进行了平滑曲线拟合、阈值饱和效应分析和亚组分析。共纳入 534 例患者，其中 65 例患者有心腔内血栓。附壁血栓是血栓的主要类型，主要位于左心室心尖部。D-二聚体诊断心腔内血栓的最佳截断值为 484ng/ml，其敏感性和特异性分别为 0.769 和 0.646。在未调整和调整后的逻辑回归模型中，D-二聚体与心腔内血栓均呈正相关。曲线拟合和阈值效应分析显示，D-二聚体与心腔内血栓之间存在两个拐点（非线性检验：P=0.032）。当 D-二聚体等于 362ng/ml 时，比值比（OR）为 1，血栓风险逐渐增加，直到达到 4096ng/ml，之后趋势不再增加。在这个范围内，D-二聚体增加一倍，血栓风险增加 103.2%（OR=2.032；95%CI 1.293-3.193；P<0.01）。在亚组分析中，D-二聚体和 BMI 对心腔内血栓有显著的交互作用（交互作用 P 值为 0.013），BMI≥25kg/m2 的患者风险更高（OR=3.44；95%CI 1.86-6.36；P<0.01）。
