Abstract | BACKGROUND: To determine whether C-reactive protein (CRP) in combination with a stroke risk stratification scheme can help in identifying transesophageal echocardiographic (TEE) markers of thromboembolism such as left atrial (LA)/left atrial appendage (LAA) thrombus, severe LA/LAA spontaneous echocardiographic contrast (SEC), and aortic plaque ≥ 4 mm. METHODS: Transthoracic echocardiography, TEE, and CRP measurement were performed at admission in 178 patients with non-valvular atrial fibrillation not receiving oral anticoagulant therapy. Patients were classified as at low, moderate, or high risk of thromboembolism based on seven clinical risk stratification schemes ( SPAF, CHADS(2), Framingham, Birmingham/NICE, ACC/AHA/ESC 2006 guidelines, ACCP 2008, CHA(2)DS(2)VASc). RESULTS: Severe LA/LAA SEC, LA/LAA thrombus, and aortic plaque ≥ 4 mm were present in 6.2%, 6.7%, and 10.1% of patients, respectively. The combination of CRP with a cut-off value of 3.4 mg/L with the Birmingham/Nice or ACC/AHA/ESC 2006 risk score, led to a negative predictive value of 100% in low-risk patients and 91% in moderate-risk patients. For the detection of severe LA/LAA SEC or thrombus, a good discrimination (area under curve ≥ 0.70) using only clinical risk markers was observed for all classifications except for the Framingham and CHADS(2) risk scores. The addition of CRP did not improve the detection of LA/LAA SEC or thrombus, or of severe LA/LAA SEC, thrombus, or aortic plaque. CONCLUSION: The combination of clinical risk markers and CRP can help to exclude the presence of the TEE markers LA/LAA SEC or LA/LAA thrombus, particularly in patients classified at low or moderate risk of stroke.
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Authors | Stéphane Ederhy, Emanuele Di Angelantonio, Ghislaine Dufaitre, Catherine Meuleman, Joelle Masliah, Louise Boyer-Chatenet, Franck Boccara, Ariel Cohen |
Journal | International journal of cardiology
(Int J Cardiol)
Vol. 159
Issue 1
Pg. 40-6
(Aug 09 2012)
ISSN: 1874-1754 [Electronic] Netherlands |
PMID | 21402418
(Publication Type: Journal Article)
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Copyright | Copyright © 2011 Elsevier Ireland Ltd. All rights reserved. |
Chemical References |
- Biomarkers
- C-Reactive Protein
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Topics |
- Aged
- Aged, 80 and over
- Atrial Fibrillation
(diagnosis, epidemiology, metabolism)
- Biomarkers
(metabolism)
- C-Reactive Protein
(metabolism)
- Cohort Studies
- Echocardiography, Transesophageal
(methods)
- Female
- Humans
- Male
- Middle Aged
- Prospective Studies
- Risk Factors
- Thromboembolism
(diagnosis, epidemiology, metabolism)
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