Response to Letter Regarding Article, “Diagnosis of Acute Aortic Dissection by D-Dimer: The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) Experience”

Abstract

knowledge, the first to determine the prevalence of acute aortic dissection in patients suspected of having this disease. Our earlier study showed a prevalence of 25%, 1 and the described study was Ϸ40%. 2 Because our conditions were limited to tertiary centers that see and treat aortic dissection routinely and thus likely have increased awareness to this disease, we noted that these figures are most likely higher than those that will be seen in the community setting. Thus, we described likelihood ratios rather than predictive values because the latter is affected by prevalence. Dr Hugli's second issue concerns clinical spectrum. Our study and its findings were based on patients with suspected acute aortic dissection and not chest pain in general; thus, caution is needed in the generalization of our findings beyond the tested parameters of patients with acute aortic dissection presenting to mainly tertiary centers. Furthermore, on the topic of selection and verification bias, results of D-dimer measurements were not made available to the treating physician; therefore, this bias was not applicable to the present study. We disagree with the reasoning that examination of consecutive cases may have caused selection bias but rather assert that this allowed a more unbiased selection process. Although our present findings are limited to the described conditions, we believe that D-dimer is useful at present and that our findings, as an initial step, will help make possible the actual clinical use of D-dimer for acute aortic dissection and provide a diagnostic algorithm to optimize the use of imaging tests in these settings. We expect our findings to serve as a "working hypothesis" to be tested in more general settings such as in patients presenting with chest pain in general and in extension to the community setting (eg, nontertiary centers, healthcare systems) and further in studies that address usefulness of diagnostic strategies that incorporate both biochemical and imaging tests. We envision that a clinical algorithm will be developed that assigns patients to clinical risk groups that will help distinguish between high-risk patients who go directly to imaging and moderate-risk groups and identify lower-risk groups in which D-dimer may emerge as a rule-out screening measure.

Retracted: Evaluation of the circulating MicroRNA‐495 and Stat3 as prognostic and predictive biomarkers for lower extremity deep venous thrombosis

“…29 D-dimer tends to increase in acute aortic dissection and D-dimer level might be significant for suspected aortic dissection patients to eliminate aortic dissection if performed within the first 24 h following the onset of symptoms. 30 Blood coagulation factor V plays a crucial role in increasing plasma prothrombin level. 31 From our findings, we concluded that for all the aforementioned indexes were identical in our study to the quoted studies above.…”

Aortic Dissection and Sudden Unexpected Deaths: A Retrospective Study of 31 Forensic Autopsy Cases

“…The elevated D‐dimer may help physicians considering the possibility of acute aortic dissection. The D‐dimer, however, may not always elevate in patients with acute aortic dissection if there is a lack of communication between true and false lumen . In our study, 23 patients had recorded D‐dimer test.…”

Acute aortic dissection: Pitfalls in the diagnosis

“…In the setting of suspected aortic dissection; biomarkers such as troponin, D-dimers and electrocardiogram (ECG) changes may be used strategically in combination with swift imaging for definitive diagnosis. [12][13][14][15] The absence of both D-dimer elevation and ECG changes is considered specific to rule out AAD. D-dimers when elevated above 500 mg/L appear to correlate with the extent and severity of AAD, but fail to distinguish AAD from pulmonary embolism.…”