The ratio of d-dimer to brain natriuretic peptide may help to differentiate between cerebral infarction with and without acute aortic dissection

Okazaki, Toshiyuki; Yamamoto, Yoko; Yoda, Keishi; Saijo, Nagahiro

doi:10.1016/j.jns.2014.03.011

Cited by 12 publications

(5 citation statements)

References 35 publications

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“…1). We finally found 22 eligible articles11121314151617181920212223242526272829303132. Most studies were from Asian and European countries (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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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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“…1). We finally found 22 eligible articles11121314151617181920212223242526272829303132. Most studies were from Asian and European countries (Table 1).…”

Section: Resultsmentioning

confidence: 99%

“…During the last 10 years, an increasing number of case-control and observational studies have reported the diagnostic accuracy of D-dimer for AAD11121314151617181920212223242526272829303132. In addition, a few systematic reviews and meta-analyses have calculated the pooled sensitivity and specificity using a univariate fixed- or random-model567891027.…”

mentioning

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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“…The initial D-dimer level was reported to be a useful indicator of AAD in patients with AIS [27] or a marker for ruling out aortic dissection [28][29][30] . D-dimer could also be elevated in patients with AIS, especially in cardioembolic patients [31] , but the initial D-dimer level in aortic dissection patients was far higher than in those with AIS [32] . Therefore, the D-dimer level could differentiate patients with AAD from those without AAD in patients presenting with AIS.…”

Section: Predictors For Aad In Patients Presenting With Aismentioning

confidence: 94%

Frequency and Detection of Stanford Type A Aortic Dissection in Hyperacute Stroke Management

Sakamoto¹,

Koga²,

Ohara³

et al. 2016

Cerebrovasc Dis

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Background and Purpose: Acute Stanford type A aortic dissection (AAD) is a devastating aortic disease, and prompt diagnosis is sometimes difficult to make. Identification of AAD in suspected acute stroke patients is especially challenging. Nevertheless, the frequencies and predictive factors of AAD in suspected acute stroke patients have not been well investigated. The aim of this study was to elucidate the prevalence of and predictors for AAD in patients with suspected acute stroke. Methods: From January 2012 through January 2013, consecutive patients who visited our emergency department (ED) due to suspected acute (<24 h from onset) stroke were retrospectively enrolled. Clinical parameters including systolic blood pressure (SBP) and laboratory data were collected. Frequency of AAD in suspected acute stroke patients and acute ischemic stroke (AIS) subjects were assessed, and factors associated with AAD among AIS patients were investigated. Results: A total of 1,637 patients were included in this study. Five patients (0.31%, 95% CI 0.04-0.57) were diagnosed as having AAD. The prevalence of AAD in all AIS individuals during the study period was 1.09% (95% CI 0.14-2.05), and AAD accounted for 1.70% (95% CI 0.05-3.36) of AIS patients who appeared at the hospital within 4 h from onset. Most AAD patients presented with disturbed consciousness, and none of the AAD patients complained of chest pain. Neck ultrasonography detected an intimal flap in AAD patients. Two AAD cases died soon after ED arrival. The remaining 3 were promptly diagnosed as having AAD in the ED and underwent emergency surgery; all were discharged with only mild neurological symptoms. Low SBP in the right arm (cut-off value ≤110 mm Hg, sensitivity 100%, specificity 94.4%) and high D-dimer level (cut-off value ≥5.0 μg/ml, sensitivity 100%, specificity 91.7%) had high predictive values for detecting AAD in patients with AIS presenting within 4 h from onset. Conclusions: AAD was seen in 0.31% of suspected acute stroke patients and 1.70% of AIS patients presenting within 4 h from onset. AAD patients who were initially suspected as having acute stroke had severe neurological symptoms, including disturbance of consciousness, did not complain of typical chest pain, and when emergency surgery was performed, favorable neurological and survival outcomes were achieved. Low SBP in the right arm and high D-dimer level could predict AAD.

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“…AoD patients with stroke had a significantly higher DD as compared with any other stroke subtypes and their B-type natriuretic peptide (BNP) concentrations were significantly lower in comparison to patients with cardioembolic stroke. Moreover, DD:BNP ratio was significantly higher in AoD patients with stroke than in patients with any other stroke subtypes (within 6 h of onset, sensitivity was 81.8% and specificity 96.4%) 41 . In a study using DD as a screening tool in patients not highly suspected of having AoD, the clinical picture and physician's judgment remained principal, despite a well-known high sensitivity of DD for AoD 42 .…”

Section: Diagnostic Potential Of Dd In Aodmentioning

confidence: 81%

Biomarkers in aortic dissection, including specific causes of troponin elevation

et al. 2016

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The ratio of d-dimer to brain natriuretic peptide may help to differentiate between cerebral infarction with and without acute aortic dissection

Cited by 12 publications

References 35 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

Frequency and Detection of Stanford Type A Aortic Dissection in Hyperacute Stroke Management

Biomarkers in aortic dissection, including specific causes of troponin elevation

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