title: The ratio of D-dimer to brain natriuretic peptide may help to differentiate between cerebral infarction with and without acute aortic dissection.
abstract: BACKGROUND
  Previous studies reported that the plasma d-dimer level reflects the activity of thrombus formation in the left atrium of patients with acute cerebral infarction and acute aortic dissection (AAD). Brain natriuretic peptide (BNP) is considered to be a marker of chronic heart failure. The differential diagnosis in the emergency room between stroke due to cardioembolism and AAD is difficult but important for early treatment especially in patients requiring intravenous thrombolysis with a recombinant tissue-type plasminogen activator. We aimed to investigate the association between the plasma d-dimer and BNP levels in patients with cerebral infarction and AAD.
  
  
  METHODS
  We identified 115 consecutive patients with ischemic stroke who were admitted within 72 h of symptom onset and 15 consecutive patients with AAD and measured the level of plasma d-dimer and BNP and the d-dimer:BNP ratio.
  
  
  RESULTS
  In patients with AAD the d-dimer level was significantly higher than that in patients with any other stroke subtypes and their BNP level was significantly lower than that in patients with cardioembolic stroke. The d-dimer:BNP ratio was significantly higher in patients with AAD than in those with any other stroke subtype. Compared to patients with a cardioembolic stroke subtype they manifested significantly higher d-dimer levels and d-dimer:BNP ratios suggesting that this ratio may help to diagnose cerebral infarction due to AAD (sensitivity 80%, specificity 93.5%, cut-off 0.074). When the population was limited to patients within 6h of onset, the ratio had higher sensitivity and specificity at the same cut-off value (sensitivity 81.8%, specificity 96.4%).
  
  
  CONCLUSIONS
  We found that the d-dimer:BNP ratio may be helpful in distinguishing between cerebral infarction with and without AAD.
authors.affiliation: Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, Japan. Electronic address: tokazaki1978@sirius.ocn.ne.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Neurosurgery, Tokushima Prefectural Miyoshi Hospital, Japan.
authors.forename: Keishi
authors.initials: K
authors.lastname: Yoda
authors.affiliation: Department of Neurosurgery, The University of Tokushima Graduate School, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000150:complications / Q000378:metabolism*; D002544:Cerebral Infarction / Q000150:complications / Q000378:metabolism*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D020097:Natriuretic Peptide, Brain
keywords: Acute aortic dissection; BNP; Cardioembolic stroke; Cerebral infarction; d-Dimer; rt-PA