Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes

Nazerian, Peiman; Müeller, Christian; Soeiro, Alexandre de Matos; Leidel, Bernd A.; Salvadeo, Sibilla A T; Giachino, Francesca; Vanni, Simone; Grimm, Karin; Oliveira, Múcio Tavares de; Pivetta, Emanuele; Lupia, Enrico; Grifoni, Stefano; Morello, Fulvio

doi:10.1161/circulationaha.117.029457

Cited by 223 publications

(201 citation statements)

References 26 publications

Supporting

Mentioning

185

Contrasting

Unclassified

Order By: Relevance

“…D‐dimer has been considered a sensitive but nonspecific marker for AAD. However, recent retrospective7 and prospective10 studies showed that if used in combination with an aortic dissection risk scoring system, D‐dimer testing has negative predictive values as high as 98.9%7 and 99.7%10 in patients with AAD. We believe such a combination of tests will become the standard diagnostic approach used to confirm or rule out AAD.…”

Section: Discussionmentioning

confidence: 99%

“…D‐dimer is now commonly measured not only following fibrinolytic therapy but also in the diagnosis of various diseases, including pulmonary embolism, disseminated intravascular coagulation, sepsis, malignancy, and acute myocardial infarction 4, 5. The utility of D‐dimer assessment in the diagnosis of acute aortic syndrome, including AAD, is well recognized 6, 7, 8, 9, 10. The European Society of Cardiology Guidelines recommends D‐dimer elevation as a IIa indication for a diagnostic workup of acute aortic syndrome,11 and previously reported studies have shown correlation between D‐dimer concentrations and the extent of aortic dissection 12, 13, 14.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Itagaki

Kimura

Mieno

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundClinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified.Methods and ResultsD‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) (P<0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21).ConclusionsD‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Itagaki

Kimura

Mieno

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…Moreover, strict monitoring of the D‐dimer level may be valuable for determining potentially fatal evolution. D‐dimer >500 ng/mL is highly sensitive for ruling out classic acute aortic dissection within the first 6 hours after symptom onset, and <500 ng/mL may be found in patients with IMH . Additionally, the negative correlation between diabetes and aortic aneurysms is well described, and patients with diabetes have a reduced prevalence of thoracic and abdominal aortic aneurysms .…”

Section: Discussionmentioning

confidence: 99%

“…D-dimer >500 ng/mL is highly sensitive for ruling out classic acute aortic dissection within the first 6 hours after symptom onset, and <500 ng/mL may be found in patients with IMH. 32,33 Additionally, the negative correlation between diabetes and aortic aneurysms is well described, and patients with diabetes have a reduced prevalence of thoracic and abdominal aortic aneurysms. 34,35 Is tight glycemic control still necessary for IMH patients since diabetes is probably a protective factor?…”

Section: Predictors Of Aorta-related Mortalitymentioning

confidence: 99%

The evolution of treatments for uncomplicated type B intramural hematoma patients

Jiang

Feng

et al. 2020

J Card Surg

View full text Add to dashboard Cite

Objectives We aimed to investigate whether uncomplicated type B intramural hematoma (IMHB) patients with known evolution predictors could benefit from more aggressive therapy. Methods Retrospective analysis was performed in uncomplicated IMHB patients with evolution predictors between January 2001 and August 2018. Cox proportional hazard models were constructed to identify the specific factors associated with aorta‐related mortality. Results A total of 226 uncomplicated acute IMHB patients with evolution predictors were included. The conventional therapy group included 187 patients, and the other 39 patients received the more aggressive therapy. Aorta‐related mortality in the first year was higher in the conventional therapy group than in the more aggressive therapy group (15% vs 2.5%, P = .035), and more patients died after thoracic endovascular aortic repair (TEVAR) (13 of 27 patients, 48.1% vs 2.5%, P < .001). The more aggressive therapy group had a higher rate of hematoma resolution than the conventional therapy group (81.6% vs 62.2%, P = .024), a lower possibility of hematoma worsening (2.6% vs 17.0%, P = .021), and a lower reintervention rate (0% vs 11.9%, P = .028). Cox regression analysis revealed that a higher rate of focal intimal disruption (FID) development (hazard ratio [HR], 3.99; 95% confidence interval [CI], 1.16‐11.46, P = .010), and a higher C‐reactive protein (CRP) level (HR, 1.27; 95% CI, 1.16‐1.40, P < .001) were associated with increased aorta‐related mortality. Conclusions More aggressive therapy for uncomplicated IMHB patients with evolution predictors during the acute phase may result in better clinical outcomes. A higher rate of FID development and a higher CRP level are associated with increased aorta‐related mortality.

show abstract

“…Ascending AAD occurs most commonly between 50 and 60 years of age. In the 2010 guidelines, the American Heart Association and the American College of Cardiology introduced the aortic dissection detection risk score (ADDRS) as a simple and systematic bedside tool guiding the diagnostic approach to suspected AAD that was revised in 2017 including the D‐dimer assay. Hereby, we present a 64‐year‐old patient with a typical atrial fibrillation (AF)—a condition actually nonincluded into the ADDRS—masking an AAD Stanford type‐A extended into the right coronary artery (RCA) originating from the aortic false lumen, axillary artery aneurysm, and thrombosis.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation, an epiphenomenon of acute Stanford type‐A aortic dissection with suspected intimo‐intimal intussusception

Ciulla

Vivona

Lemos

et al. 2018

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

Diagnostic Accuracy of the Aortic Dissection Detection Risk Score Plus D-Dimer for Acute Aortic Syndromes

Abstract: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02086136.

Cited by 223 publications

References 26 publications

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D‐Dimer Concentration

The evolution of treatments for uncomplicated type B intramural hematoma patients

Atrial fibrillation, an epiphenomenon of acute Stanford type‐A aortic dissection with suspected intimo‐intimal intussusception

Contact Info

Product

Resources

About