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Diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation: A systematic review and meta-analysis
Heart Rhythm ( IF 5.5 ) Pub Date : 2021-09-01 , DOI: 10.1016/j.hrthm.2021.08.027
Carlos Diaz-Arocutipa 1 , Ana C Gonzales-Luna 2 , Ana Brañez-Condorena 3 , Adrian V Hernandez 4
Affiliation  

Background

There is conflicting evidence about the use of biomarkers to diagnose left atrial thrombus in patients with atrial fibrillation.

Objective

The purpose of this study was to assess the diagnostic accuracy of D-dimer to detect left atrial thrombus in patients with atrial fibrillation.

Methods

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.

Results

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.

Conclusion

Our meta-analysis suggests that D-dimer has the potential to be useful to rule out left atrial thrombus in patients with atrial fibrillation.



中文翻译:

D-二聚体检测心房颤动患者左心房血栓的诊断准确性:系统评价和荟萃分析

背景

关于使用生物标志物诊断心房颤动患者的左心房血栓,存在相互矛盾的证据。

客观的

本研究的目的是评估 D-二聚体检测心房颤动患者左心房血栓的诊断准确性。

方法

我们检索了从成立到 2020 年 12 月 16 日的 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。使用诊断准确性研究的质量评估 2 工具评估研究质量。我们使用双变量模型来计算汇总的敏感性和特异性及其 95% 置信区间 (CI)。还估计了最佳截止值和预测值。

结果

纳入 11 项横断面研究,涉及 4380 名患者。左心房血栓的中位患病率为 12%。在 7 项研究中,500 ng/mL D-二聚体的汇总敏感性为 50% (95% CI 26%–74%),汇总特异性为 88% (95% CI 76%–95%)。在 2 项研究中,年龄调整 D-二聚体的汇总敏感性为 36%(95% CI 14%–66%),汇总特异性为 99%(95% CI 96%–99%)。在 10 项研究中,D-二聚体的最佳截断值为 390 ng/mL,合并敏感性为 68% (95% CI 44%–85%),合并特异性为 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都较低或不清楚。几乎所有研究都对适用性的担忧很低。

结论

我们的荟萃分析表明,D-二聚体有可能有助于排除心房颤动患者的左心房血栓。

更新日期:2021-09-01
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