Diagnostic Implications of Elevated Levels of Smooth-Muscle Myosin Heavy-Chain Protein in Acute Aortic Dissection: The Smooth Muscle Myosin Heavy Chain Study

“…3 The biochemical methods for diagnosing acute myocardial infarction (AMI) have advanced greatly in the past quarter century; these methods include the use of creatinine phosphokinase (CK), the MB isozyme of CK, 4 cardiac myosin light chain, 5 troponin T, 6 and human heart fatty acid binding protein. 7,8 Meanwhile, for the diagnosis of AAD, smooth muscle myosin heavy chain 9,10 and C-reactive protein (CRP) 11 in the serum have both been reported to be such candidates. However, they also have several drawbacks: the former rapidly disappears within the first 12 hours after onset, 9,10 whereas the levels of the latter, which is a nonspecific marker of inflammation, begin to increase only the day after onset.…”

Section: See Page 1721mentioning

confidence: 99%

“…7,8 Meanwhile, for the diagnosis of AAD, smooth muscle myosin heavy chain 9,10 and C-reactive protein (CRP) 11 in the serum have both been reported to be such candidates. However, they also have several drawbacks: the former rapidly disappears within the first 12 hours after onset, 9,10 whereas the levels of the latter, which is a nonspecific marker of inflammation, begin to increase only the day after onset. 11 Therefore, the establishment and clinical availability of another simplified laboratory test(s) to help make a timely and accurate diagnosis of AAD is urgently needed.…”

Section: See Page 1721mentioning

confidence: 99%

Soluble Elastin Fragments in Serum Are Elevated in Acute Aortic Dissection

Shinohara

Suzuki

Okada

et al. 2003

ATVB

137

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Objective-We aimed to establish an enzyme-linked immunosorbent assay for measuring soluble elastin fragments (sELAF) in serum and to reveal its usefulness in diagnosing acute aortic dissection (AAD). Methods and Results-An enzyme-linked immunosorbent assay to measure sELAF in serum was developed by using the newly created double monoclonal antibodies, which recognize the different epitopes of human aortic elastin. Twenty-five AAD patients, 50 patients with acute myocardial infarction (AMI), and 474 healthy individuals were enrolled in the study. The sELAF levels from healthy subjects gradually increased with aging. When the cutoff point for positivity was set at the meanϩ3 SD (ie, 3 SD above the mean in healthy subjects at each age), 16 AAD patients (64.0%) were found be positive, whereas only 1 AMI patient was found to be positive (2.0%). AAD patients with either an open or a partially open pseudolumen were found be 88.9% positive for sELAF, whereas those with its early closure were 0% positive. The difference in the sELAF levels between AAD patients with and without a thrombotic closure of false lumen was significant (60.3Ϯ15.6 versus 135.4Ϯ53.2 ng/mL, respectively; PϽ0.005). Key Words: matrix protein Ⅲ elastin degradation Ⅲ aortic media Ⅲ intimal tear Ⅲ false lumen A cute aortic dissection (AAD) is a life-threatening medical emergency of the aorta that is associated with a high mortality. In AAD patients who do not receive immediate treatment, mortality is estimated to be 35% within the initial 24 hours, 50% within 48 hours, and 80% after 2 weeks. 1 Conclusions-The

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“…Also, SMMHC's high sensitivity (90%) for detection of AAD decreases rapidly with time, and soluble elastin has a 0% sensitivity in patients with a thrombosed false lumen (27,28). Therefore D-dimer has an advantage over SMMHC and soluble elastin in differentiating AAD.…”

Section: Discussionmentioning

confidence: 99%

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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Diagnostic Implications of Elevated Levels of Smooth-Muscle Myosin Heavy-Chain Protein in Acute Aortic Dissection: The Smooth Muscle Myosin Heavy Chain Study

Abstract: Levels of smooth-muscle myosin heavy-chain protein can be used to diagnose aortic dissection soon after symptom onset. The assay had the greatest diagnostic value in patients with proximal lesions.

Cited by 110 publications

References 19 publications

Simple and Useful Tests for Discriminating Between Acute Aortic Dissection of the Ascending Aorta and Acute Myocardial Infarction in the Emergency Setting

Simple and Useful Tests for Discriminating Between Acute Aortic Dissection of the Ascending Aorta and Acute Myocardial Infarction in the Emergency Setting

Soluble Elastin Fragments in Serum Are Elevated in Acute Aortic Dissection

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

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