title: A rapid bedside D-dimer assay (cardiac D-dimer) for screening of clinically suspected acute aortic dissection.
abstract: BACKGROUND
  A rapid laboratory test for diagnosis of acute aortic dissection (AAD) has not been available. We performed this prospective study to determine the utility of a rapid bedside D-dimer (DD) assay for detection of AAD.
  
  
  RESULTS
  Patients with suspected AAD were recruited and their DD levels were measured by rapid bedside assay. They were divided into 2 groups according to enhanced computed tomography findings: an AAD group (n = 30) and a non-AAD group (n = 48). The median DD level was higher in the AAD group (1.80 microg/ml) than in the non-AAD group (0.42 microg/ml) (p = 0.000). The rapid bedside DD assay showed 100% sensitivity, 54% specificity, 58% positive predictive value and 100% negative predictive value for detection of AAD with a normal DD level of up to 0.5 microg/ml. The combination of DD level >0.5 microg/ml and systolic blood pressure > or = 180 mmHg showed 86% positive predictive value for detection of AAD. Conclusions We conclude that the rapid bedside DD assay is a highly sensitive method for early exclusion of AAD in patients with chest and/or back pain suggestive of AAD. Acute aortic dissection is highly probable if a rapid DD assay shows the elevated DD level with systolic blood pressure > or = 180 mmHg on admission.
authors.affiliation: Intensive and Coronary Care Unit, Nippon Medical School, Tokyo, Japan. koichi-a@nms.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Akutsu
authors.forename: Naoki
authors.initials: N
authors.lastname: Sato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Norishige
authors.initials: N
authors.lastname: Morita
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Takagi
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Fujita
authors.forename: Keiji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Teruo
authors.initials: T
authors.lastname: Takano
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000175:diagnosis*; D001416:Back Pain / Q000175:diagnosis; D002637:Chest Pain / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D006973:Hypertension; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000737:chemistry; D019095:Point-of-Care Systems / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D