TY - JOUR
T1 - Significance of high sensitivity C-reactive protein and D-dimer in evaluating intracardiac thrombus and spontaneous echo contrast in patients referred for transesophageal echocardiography
T2 - A prospective study
AU - Abu-Mahfouz, Mohammed
AU - Cavalcante, João L.
AU - Arida, Muhammad
AU - Garcia, Jose
AU - Al-Mallah, Mouaz
AU - Boguszewski, Andrzej
AU - Haque, Shamael
AU - Rehman, Mohammed
AU - Al Badarin, Firas
AU - Akhras, Eyad
AU - Schultz, Lonni
AU - Mitsias, Panayiotis
AU - Alam, Mohsin
AU - Ananthasubramaniam, Karthik
N1 - Copyright:
Copyright 2012 Elsevier B.V., All rights reserved.
PY - 2012
Y1 - 2012
N2 - Background: Intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) are considered hypercoagulable and inflammatory conditions. We aimed to determine if high sensitivity C-reactive protein (CRP) and D-dimer (DD), in combination with variables of lower thrombotic risk (normal ejection fraction [NEF], sinus rhythm [NSR]), may predict the absence of ICT/SEC. Methods and Results: Consecutive patients referred for transesophageal echocardiogram (TEE) for evaluation of cardioembolic source were prospectively enrolled. CRP and DD levels were determined at the time of TEE. 124 patients were enrolled, of whom 21 had ICT/SEC. The combination of NSR/NEF had a negative predictive value (NPV) of 98.6% for absence of ICT/SEC. The NPVs of CRP and DD were 93.6% and 85%, respectively. Adding either CRP or DD to NSR/NEF combination increased the NPV to 100%. Log CRP was significantly associated with ICT/SEC. Conclusions: The presence of NSR and NEF may defer the need for TEE for ICT/SEC evaluation. CRP association with ICT/SEC suggests that inflammation plays a role in ICT/ /SEC formation. Whether CRP and DD should become routine in the triage process of TEE for ICT/SEC evaluation requires further large scale prospective studies.
AB - Background: Intra-cardiac thrombus (ICT) and spontaneous echo contrast (SEC) are considered hypercoagulable and inflammatory conditions. We aimed to determine if high sensitivity C-reactive protein (CRP) and D-dimer (DD), in combination with variables of lower thrombotic risk (normal ejection fraction [NEF], sinus rhythm [NSR]), may predict the absence of ICT/SEC. Methods and Results: Consecutive patients referred for transesophageal echocardiogram (TEE) for evaluation of cardioembolic source were prospectively enrolled. CRP and DD levels were determined at the time of TEE. 124 patients were enrolled, of whom 21 had ICT/SEC. The combination of NSR/NEF had a negative predictive value (NPV) of 98.6% for absence of ICT/SEC. The NPVs of CRP and DD were 93.6% and 85%, respectively. Adding either CRP or DD to NSR/NEF combination increased the NPV to 100%. Log CRP was significantly associated with ICT/SEC. Conclusions: The presence of NSR and NEF may defer the need for TEE for ICT/SEC evaluation. CRP association with ICT/SEC suggests that inflammation plays a role in ICT/ /SEC formation. Whether CRP and DD should become routine in the triage process of TEE for ICT/SEC evaluation requires further large scale prospective studies.
KW - C-reactive protein
KW - D-dimer
KW - Intracardiac thrombus
KW - Spontaneous echocardiography contrast
KW - Transesophageal echocardiography
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U2 - 10.5603/CJ.2012.0048
DO - 10.5603/CJ.2012.0048
M3 - Article
C2 - 22641545
AN - SCOPUS:84861966375
VL - 19
SP - 267
EP - 273
JO - Cardiology Journal
JF - Cardiology Journal
SN - 1897-5593
IS - 3
ER -