D-dimer and BNP levels in acute aortic dissection

Sbarouni, Eftihia; Γεωργιάδου, Παναγιώτα; Marathias, Aikaterini; Geroulanos, Stefanos; Kremastinos, Dimitrios Th.

doi:10.1016/j.ijcard.2006.11.056

Cited by 78 publications

(62 citation statements)

References 6 publications

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“…Patients with aneurysm and acute aortic dissection not defined as chronic were compared with a healthy control group in that study and plasma brain natriuretic peptide (BNP) levels were significantly higher compared to the control group. In contrast, it has also been reported that, unlike BNP, D-dimer can be used as an excluding test in the diagnosis of aortic dissection and can also be employed in the differential diagnosis of dissection and chronic dilatation (7).…”

Section: Discussionmentioning

confidence: 99%

The diagnostic value of ischemia-modified albumin in the diagnosis of aortic pathology

Eroğlu¹,

Turkmen²,

Menteşe³

et al. 2014

Turk J Med Sci

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This study was designed to synthesize and evaluate derivatives of scopolamine (1) as acetylcholine esterase and protease inhibitors. Scopolamine (1) was extracted from the aerial parts of Datura innoxia through bioassay guided fractionation. Five different derivatives of scopolamine (1) were synthesized, and identified through spectroscopic studies. Their acetylcholine esterase (AChE) and trypsin inhibitory potentials were determined through standard protocols and evaluated from the perspective of structure-activity relationship.The synthesized scopolamine derivatives (2-6) showed remarkable AChE inhibitory activity, except for scopoline (6). The results showed higher enzyme inhibition potential of the synthesized compounds (2-5) as compared to scopolamine (1). Maximum inhibition was exhibited by scopolamine N -oxide (89.9 ± 1.2%, IC 50 = 37.4 ± 1.1 μ M)), followed by scopolamine sulfonic acid (70.3 ± 0.8%, IC 50 = 46.9 ± 1.0 μ M) and O -methyl scopolamine (66.1 ± 1.2%, IC 50 = 94.7 ± 0.8 μ M). All derivatives showed moderate activity against trypsin; maximum activity was exhibited by 6 (54.0 ± 1.4%) with IC 50 = 621.2 ± 3.7 μ M.

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Section: Discussionmentioning

confidence: 99%

The diagnostic value of ischemia-modified albumin in the diagnosis of aortic pathology

Eroğlu¹,

Turkmen²,

Menteşe³

et al. 2014

Turk J Med Sci

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“…17,18) Sbarouni et al reported that a cutoff level of 700 ng/mL was useful, not only for suspecting acute aortic dissection, but also for ruling out chronic aortic aneurysm. 19) Transthoracic echocardiography can be a promising modality, which potentially provides the definite diagnosis of AAAD at bed side. 20,21) Cecconi reported that the sensitivity, specificity, and positive and negative predictive values for diagnosing AAAD were 87%, 91%, 75%, and 95%, respectively.…”

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confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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“…(7) and Ohlmann et al (11) found that D-dimer levels tended to be higher in patients who died during the in-hospital period. However, Weber et al (6) and Sbarouni et al (15) did not observe a difference on D-dimer levels between patients' outcome (mortality) and type of aortic dissection.…”

Section: Discussionmentioning

confidence: 90%

“…In the last years, many trials showing that D-dimer testing can be used to exclude aortic dissection safely were reported (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). In numerous studies, in which different techniques and cut-off levels have been used, the sensitivity of D-dimer test in diagnosis of aortic dissection were found between 88-100% (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

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Can D-dimer testing help emergency department physicians to detect acute aortic dissections?

Ersel¹,

Aksay²,

Kıyan³

et al. 2010

Anadolu Kardiyol Derg

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Objective: To determine the diagnostic accuracy of D-dimer testing for detection of acute aortic dissection. Methods: This study is a retrospective chart review of patients who had been evaluated with suspicion of acute aortic dissection. All patients' D-dimer levels were determined prior to their further work up in the emergency department. The study was conducted in a tertiary care center between February 2006-August 2008. The D-dimer assay used was the immunoturbidimetric assay, with a normal range up to 0.246 μg/ml. Statistical analysis was accomplished using Chi-square test, Student's t-test and a receiver-operating characteristics (ROC) curve analysis. Results: Ninety-nine patients were included in the study, 30 patients were diagnosed as having acute aortic dissection and 69 patients were evaluated in non-acute aortic dissection group. In comparison of the two groups, positive D-dimer results were found to be significantly higher in acute aortic dissection group than in non-acute aortic dissection group (p<0.001). Sensitivity of the D-dimer test in detection of acute aortic dissection was found as 96.6% and the negative predictive value of the test was 97.3%. Specificity and positive predictive value of the D-dimer test were 52.2% and 46.8%, respectively. The area under the ROC curve yielded an acceptable certainty for excluding acute aortic dissection on base of negative results (AUC: 0.764; CI 95%: 0.674-0.855; p<0.001). Conclusion: D-dimer testing is helpful for emergency physicians in detection of patients with suspected acute aortic dissection in the emergency department. (Anadolu Kardiyol Derg 2010; 10: 434-9) Key words: Acute aortic dissection, D-dimer, fibrin degradation products, emergency department, diagnostic value of tests ÖZET Amaç: D-dimer testinin akut aort disseksiyonunu belirlemede tanısal değerini saptamak. Yöntemler: Bu çalışma retrospektif bir çalışmadır. Acil serviste akut aort disseksiyonu şüphesi mevcut olan ve ileri tetkik öncesi D-dimer testi istenen hastalar çalışmaya dâhil edilmiştir. 3. basamak bir sağlık kuruluşunda gerçekleştirilen çalışmada, Şubat 2006-Ağustos 2008 tarihleri arasındaki kayıtlar incelenmiştir. Kullanılan D-dimer ölçüm yöntemi immunoturbidimetrik yöntemdir ve 0.246 μg/ml'ye kadar olan sonuçlar normal olarak kabul edilmiştir. İstatistiksel analizde Ki-kare testi, Student's t-testi kullanılmış, ayrıca ROC eğrisi analizi yapılmıştır. Bulgular: Çalışmaya 30 akut aort disseksiyonu mevcut, 69 akut aort disseksiyonu mevcut olmayan kontrol grubu olmak üzere 99 hasta dâhil edilmiştir. Bu iki gruba ait D-dimer ölçümlerinin karşılaştırılmasında akut aort disseksiyonu olan hastaların olmayanlara göre istatistiksel anlamlı olarak daha fazla pozitif sonucunun olduğu görülmüştür (p<0.001). Akut aort disseksiyonunu saptamada D-dimer testinin duyarlılığı %96.6 özgünlüğü %52.2 negatif prediktif değeri %97.3 pozitif prediktif değeri ise %46.8 olarak bulunmuştur. ROC analizi sonucunda eğri altında kalan (AUC) değeri 0.764 (CI %95: 0.674-0.855) ve p<0.001) olarak saptanmı...

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D-dimer and BNP levels in acute aortic dissection

Cited by 78 publications

References 6 publications

The diagnostic value of ischemia-modified albumin in the diagnosis of aortic pathology

The diagnostic value of ischemia-modified albumin in the diagnosis of aortic pathology

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Can D-dimer testing help emergency department physicians to detect acute aortic dissections?

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