Chest
Volume 123, Issue 5, May 2003, Pages 1375-1378
Journal home page for Chest

Clinical Investigations
SURGERY
D-dimer in Acute Aortic Dissection

https://doi.org/10.1378/chest.123.5.1375Get rights and content

Study objective:

Laboratory testing plays a minor role in the assessment of aortic dissection. Its main value is in the exclusion of other diseases. Following an incidental observation, we systematically investigated the relationship between elevated d-dimer levels and acute aortic dissection.

Design:

We prospectively tested d-dimer levels in patients with suspected acute aortic dissection (10 patients). In addition, we investigated 14 patients who had received a confirmed diagnosis of thoracic aortic dissection during the previous 5 years, in whom d-dimer testing had been performed for differential diagnosis. Thirty-five patients with acute chest pain of other origin served as a control group.

Setting:

Tertiary referral hospital.

Patients:

Twelve patients had type A dissection (Stanford classification), and 12 patients had type B.

Measurements and results:

A d-dimer analysis was performed (Tina-quant assay; Roche Diagnostics; Mannheim, Germany) [normal limit of the assay, 0.5 μg/mL]. The result of the d-dimer test was positive (ie, > 0.5 μg/mL) in all patients (sensitivity of the test, 100%) with a mean value of 9.4 μg/mL and a range of 0.63 to 54.7 μg/mL. The degree of the elevation was correlated to the delay from the onset of symptoms to laboratory testing (mean, 12.6 h; range, 1 to 120 h) and showed a trend to the extent of the dissection, but not to the outcome (14 patients could be discharged; 10 patients died).

Conclusions:

Based on our observation, we suggest that testing for d-dimer should be part of the initial assessment of patients with chest pain, especially if aortic dissection is suspected. A negative test result makes the presence of the disease unlikely.

Section snippets

Materials and Methods

We prospectively tested d-dimer levels in patients with acute aortic dissection (10 patients). In addition, we identified 54 patients who had received this diagnosis in the previous 5 years in our hospital database. In 14 of these patients, a d-dimer test had been performed for differential diagnosis, and the results of those tests were included in our analysis. Thirty-five consecutive patients who were admitted to our cardiology ICU due to acute chest pain of an origin other than aortic

Patients

Baseline characteristics are shown in Table 1, and dissection types, management, and clinical outcomes in Table 2. The diagnostic procedures were as follows: TTE, 23 patients (96%); TEE, 5 patients (21%); CT scanning, 17 patients (71%); MRI, 4 patients (17%); and angiography, 4 patients (17%). In seven patients with type A dissection, no surgery was performed because of refusal by the surgeon or the patient.

Control Group

The final diagnoses for the 35 consecutive patients with acute chest pain were as

Discussion

Acute dissection is a rare but often catastrophic illness. Early and accurate diagnosis and treatment are crucial for survival. The most common clinical presentation of persons with the disease is severe chest pain.4 Associated clinical criteria like pulse or BP differentials can be helpful in suspecting the diagnosis,5 but they are present only in a minority of patients.6 So, the authors of a multicenter registry6 concluded that a high clinical index of suspicion is necessary for rapid

Conclusion

These data provide evidence that a negative d-dimer test result could be useful in excluding acute thoracic aortic dissection.

References (16)

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