D-Dimer assay as a non invasive test for the diagnosis of left atrial Thrombi in Indian patients with Rheumatic MS

M Rajappa, STN Roy, A Raj, V Trehan, V Mallika

Abstract

Background: Systemic embolism is a serious and sometime fatal complication of rheumatic MS.

Objective: We assessed the predictive power of D-Dimer level to predict occurrence of left atrial (LA) thrombi in patients with rheumatic mitral stenosis (MS).

Methods: D-dimer levels were analyzed for 24 patients with rheumatic MS with LA clot and 22 patients with rheumatic MS with no LA clot undergoing transeosophageal echocardiography. A level more than 4 ìg/ml was taken as elevated to predict the presence of LA clot in the study groups.

Results: For a cut-off value of 4 ìg/ml, sensitivity was 66.67 % and  specificity 100 % for prediction of LA clot and AUC 0.710. A cut-off value of less than 1 ìg/ml, sensitivity was 91.67 % and 87. 5 % negative predictive value for ruling out presence of LA clot and AUC 0.721.

Conclusions: A higher value of D-dimer can predict the possible presence of a LA clot and very low value can predict absence of clot in patients with rheumatic MS.

Key words: Rheumatic MS, Left atrial thrombus, D-Dimer levels, Transoesophageal echocardiography