الفهرس Only 14 pages are availabe for public view
 |  | from | 94 |  |  |
| | | from | 94 | | |
Abstract
• Atrial fibrillation is a strong risk factor for stroke, as stated by one of the most popular studies its incidence is five times more than patients with sinus rhythm and 17 times more in patients with AF secondary to RHD. Therefore great attention should be given as regard risk factors of AF, thromboembolic manifestations and appropriate anticoagulation.
•
• This work was set to investigate the ability of a simple laboratory test as D-Dimer has the ability to diagnose the presence of LAA thrombi formation in patients with chronic AF associated with RHD or non-rheumatic heart disease. This study was also performed to see if D-Dimer could replace TEE for diagnosis of LAA thrombi formation, and so becomes a more simple and easy tool for diagnosis of thrombus formation and prevent serious thromboembolic manifestations especially if the treating physican take the decision of medical or electrical cardioversion.
•
• Fourty patients were included in this study all with chronic AF. Twenty with RHD and the other twenty with NVAF. They all had to fulfill the following criteria.
• The patients must have been fibrillating for more than 12 months.
• No contraindications for the use of TEE.
• Patients selected must not complain of any condition that may elevated D-Dimer values as pulmonary embolism, contraceptive pills, deep vein thrombosis, cancer etc.
• Full medical check up to all patients and good history taking as regards the duration of the present illness, medication and the presence of any other associated conditions or complications.
• Resting ECG to confirm AF and the presence of any ischemic changes.
• 2 D echocardiography was used to estimated the LV EF, the severity of MS LVH, wall motion abnormality and LA diameter.
• TEE was used to all patients immediately after a venous sample was taken for D-Dimer and bleeding profile to examine the presence or absence of thrombi.
Patients age was between 21-68 years ( mean 48 years) in the RHD group and 23-80 years (mean 68 years) in the non rheumatic group, and the following was noticed among the group that were diagnosed thrombi +ve by TEE (14 patients):
• 12 patients had a high D-Dimer value (85.7%) and 2 patients had a low D-Dimer value (14.3%) which confirms the high accuracy of D-Dimer for diagnoses.
• 10 patients of the total 14 patients were from the RHD group, which concludes that this group is more liable for thrombus formation as compared the NVAF group.
• Hypertension was the most important risk factor for thrombus formation.
• In the NVAF group thrombus formation requires the presence of atleast one risk factor, whereas in the RHD group thrombus formation is not related to the presence of risk factors.
As regards patients that were diagnosed by TEE to be free from thrombus formation (26 patients) the following was noticed:
• 24 patients had a low D-Dimer value and only 2 patients had a high D-Dimer value.
• Most patients had few or no risk factors.
• LA size was of normal size in most patients.
This study concluded the total accuracy of D-Dimer to diagnose LA thrombi of approximately 90%, and that the RHD group of patients with AF are more liable for thrombus formation than the NVAF group even without risk factors and so appropriate anticoagulation therapy showed be immediately started among this group regardless to the presence or absence of risk factors. As regards the NVAF group there should be a good risk stratification as regards risk factors of thromboembolism, risk to benefit evaluation and accordingly