Can a Negative D-dimer Result Rule Out Acute Aortic Dissection?

Brown, Michael D.; Newman, David H.

doi:10.1016/j.annemergmed.2011.04.016

Cited by 15 publications

(8 citation statements)

References 5 publications

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“…Even though the sensitivity and NPV of D-dimer are very good, D-dimer may overlook AAD46. False negative D-dimer are often observed for a young population, short dissection length, and thrombosed false lumen1117.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic test accuracy of D-dimer for acute aortic syndrome: systematic review and meta-analysis of 22 studies with 5000 subjects

Watanabe

Horita

Shibata

et al. 2016

Sci Rep

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Diagnostic test accuracy of D-dimer for acute aortic dissection (AAD) has not been evaluated by meta-analysis with the bivariate model methodology. Four databases were electrically searched. We included both case-control and cohort studies that could provide sufficient data concerning both sensitivity and specificity of D-dimer for AAD. Non-English language articles and conference abstract were allowed. Intramural hematoma and penetrating aortic ulcer were regarded as AAD. Based on 22 eligible articles consisting of 1140 AAD subjects and 3860 non-AAD subjects, the diagnostic odds ratio was 28.5 (95% CI 17.6–46.3, I2 = 17.4%) and the area under curve was 0.946 (95% CI 0.903–0.994). Based on 833 AAD subjects and 1994 non-AAD subjects constituting 12 studies that used the cutoff value of 500 ng/ml, the sensitivity was 0.952 (95% CI 0.901–0.978), the specificity was 0.604 (95% CI 0.485–0.712), positive likelihood ratio was 2.4 (95% CI 1.8–3.3), and negative likelihood ratio was 0.079 (95% CI 0.036–0.172). Sensitivity analysis using data of three high-quality studies almost replicated these results. In conclusion, D-dimer has very good overall accuracy. D-dimer <500 ng/ml largely decreases the possibility of AAD. D-dimer >500 ng/ml moderately increases the possibility of AAD.

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Section: Discussionmentioning

confidence: 99%

Diagnostic test accuracy of D-dimer for acute aortic syndrome: systematic review and meta-analysis of 22 studies with 5000 subjects

Watanabe

Horita

Shibata

et al. 2016

Sci Rep

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show abstract

“…Taken together, available data have clearly established that DD represents a highly sensitive and largely unspecific biomarker of AD. If associated with a sufficiently low pretest probability of AD (as established by validated clinical prediction rules), a negative DD could therefore reliably and safely ruleout AD [45]. Instead, available data indicate that DD is less sensitive (90%) for the diagnosis of aortic intramural aortic hematoma, probably due to the limited communication of the core lesion with the true aortic lumen [46].…”

Section: Coagulation and Inflammation Markers D-dimermentioning

confidence: 94%

Biomarkers for Diagnosis and Prognostic Stratification of Aortic Dissection: Challenges and Perspectives

et al. 2014

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Aortic dissection (AD) is a severe vascular disease associated with major morbidity and mortality. The diagnosis of AD requires the performance of urgent aortic imaging exams such as computed tomography angiography, but the decision to perform these exams now essentially relies on clinical judgment. Several studies have identified a range of potential biomarkers stemming from the aortic extracellular matrix (matrix metalloproteinases, TGF-β, soluble elastin fragments), vascular smooth muscle cells (smooth muscle myosin heavy chain, creatine kinase, calponin), coagulation (D-dimer, platelets) and inflammation (C-reactive protein), whose circulating levels increase in patients affected by AD. Biomarkers of AD could be potentially used to screen patients with compatible symptoms, to identify patients at higher risk of AD, to rule out AD in patients with non-high clinical probability of AD and/or to obtain prognostic stratification of affected patients. This review will summarize available data and discuss present and future perspectives of circulating biomarkers for the diagnosis and prognostic stratification of AD.

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“…Further research may clarify this issue [Song 2011]. The role of biomarkers, eg, D-dimer, in the diagnosis of aortic dissection is still controversial, and their role in diagnosing IMH is even less clear [Evangelista 2005;Brown 2011;Citro 2011].…”

Section: Discussionmentioning

confidence: 99%

Acute Aortic Intramural Hematoma Presenting with Painless Recurrent Syncope

Droste¹,

Zadeh²,

Arif³

et al. 2012

HSF

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A patient presented with recurrent syncope due to transient severe hypotension. The patient's history, physical examination, and initial baseline investigation did not suggest a cardiovascular cause. After fluid resuscitation, a raised jugular venous pulse was noted. Bedside transthoracic echocardiogram showed a pericardial effusion and a proximally dilated aorta. Computed tomography of the thorax confirmed these findings and also demonstrated an intramural hematoma of the proximal aortic wall.The patient was transferred to a cardiothoracic center, where he was at first treated medically. He then developed sudden cardiogenic shock due to pericardial tamponade and was successfully operated on.It is important to recognize an acute intramural hematoma of the proximal aortic wall as a cardiothoracic emergency. This condition can present atypically, but nevertheless warrants urgent surgical intervention, equal to type A aortic dissection. Echocardiography can help in making the diagnosis.

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Can a Negative D-dimer Result Rule Out Acute Aortic Dissection?

Cited by 15 publications

References 5 publications

Diagnostic test accuracy of D-dimer for acute aortic syndrome: systematic review and meta-analysis of 22 studies with 5000 subjects

Diagnostic test accuracy of D-dimer for acute aortic syndrome: systematic review and meta-analysis of 22 studies with 5000 subjects

Biomarkers for Diagnosis and Prognostic Stratification of Aortic Dissection: Challenges and Perspectives

Acute Aortic Intramural Hematoma Presenting with Painless Recurrent Syncope

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