Diagnostic and prognostic value of circulating D-Dimers in patients with acute aortic dissection.
OBJECTIVE
We sought to determine whether assessing D-Dimer might be helpful for the management of acute aortic dissection (AAD).


METHODS
Single-center retrospective case-control study.


METHODS
University Hospital of Strasbourg France.


METHODS
Patients were 94 consecutive patients admitted to our institution with confirmed AAD and in whom D-Dimer test had been performed at presentation. These patients were matched with 94 controls presenting with clinical suspicion of dissection, which was later ruled out.


METHODS
Patient characteristics and clinical course were analyzed.


RESULTS
Ninety-three (99%) patients with AAD had elevated D-Dimer (>400 ng/mL) with a median D-Dimer value of 8610 ng/mL (interquartile range, 2982-20,000 ng/mL). Receiver operating characteristic curves analysis showed that D-Dimer, but not C-reactive protein, troponin, lactate dehydrogenase, or leukocyte count, was predictive of a diagnosis of AAD, with a sensitivity and specificity of 99% and 34%, respectively. D-Dimer concentration positively correlated with the anatomical extension of the dissection to the different segments of the aorta (R = .47, p < .0001). A positive relationship was observed between D-Dimer and in-hospital mortality rate among patients with AAD (p = .037). On multivariate analysis, the independent predictors of in-hospital mortality were the presence of pericardial effusion (odds ratio, 6.80; confidence interval, 1.87-27.60), D-Dimer >5200 ng/mL (odds ratio, 5.38; confidence interval, 1.27-30.87), and female gender (odds ratio, 4.96; confidence interval, 1.39-19.95).


CONCLUSIONS
D-Dimers are elevated in patients with AAD and provide valuable diagnostic and prognostic information. In patients with acute chest pain and elevated D-Dimer, a diagnosis of AAD should also be considered. D-Dimer might be a useful complementary tool to the current diagnostic work-up of patients with suspected AAD.
Fédération of cardiologie, Service de chirurgie cardiaque, Hôpitaux Universitaires de Strasbourg, France.
Patrick
P
Ohlmann
Antoine
A
Faure
Olivier
O
Morel
Hélène
H
Petit
Hasna
H
Kabbaj
Nicolas
N
Meyer
Edouard
E
Cheneau
Laurence
L
Jesel
Eric
E
Epailly
Dominique
D
Desprez
Lelia
L
Grunebaum
Francis
F
Schneider
Gerald
G
Roul
Jean-Philippe
JP
Mazzucotteli
Bernard
B
Eisenmann
Pierre
P
Bareiss
D000208:Acute Disease; D000784:Aortic Dissection / Q000175:diagnosis* / Q000401:mortality; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000401:mortality; D015415:Biomarkers; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D