Diagnosis of Acute Aortic Dissection by D-Dimer

Abstract

Background-D-dimer has been reported to be elevated in acute aortic dissection. Potential use as a "rule-out" marker has been suggested, but concerns remain given that it is elevated in other acute chest diseases, including pulmonary embolism and ischemic heart disease. We evaluated the diagnostic performance of D-dimer testing in a study population of patients with suspected aortic dissection. Methods and Results-In this prospective multicenter study, 220 patients with initial suspicion of having acute aortic dissection were enrolled, of whom 87 were diagnosed with acute aortic dissection and 133 with other final diagnoses, including myocardial infarction, angina, pulmonary embolism, and other uncertain diagnoses. D-dimer was markedly elevated in patients with acute aortic dissection. Analysis according to control disease, type of dissection, and time course showed that the widely used cutoff level of 500 ng/mL for ruling out pulmonary embolism also can reliably rule out aortic dissection, with a negative likelihood ratio of 0.07 throughout the first 24 hours. Conclusion-D-dimer levels may be useful in risk stratifying patients with suspected aortic dissection to rule out aortic dissection if used within the first 24 hours after symptom onset.

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

“…A very recent study (19) supports findings of the previous and our study. In that prospective multicenter study, 220 patients with initial suspicion of having AAD were enrolled, of whom 87 were diagnosed with AAD and 133 with other final diagnoses.…”

“…According to the results of the study, D-dimer test can reliably rule out aortic dissections, even at the widely used cut-off level of 500 ng/mL used for ruling out pulmonary embolism, within the first 24 hours after symptom onset. Authors pointed out that D-dimer levels may be useful in risk stratifying patients with suspected aortic dissection to rule out aortic dissection (19).…”

“…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).…”

“…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). In some studies the sensitivity of D-dimer test reached up to 100% (6-8, 10, 17).…”

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

“…In addition to dissection morphologic features, age12 and the time between the onset of symptoms and D‐dimer testing14, 33 have been reported to influence the D‐dimer concentration. The serum D‐dimer concentration has been reported to increase within 6 hours after the onset of aortic dissection and to peak within 24 hours 20, 33. D‐dimer has a half‐life of ≈8 hours 5.…”