title: Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes.
abstract: BACKGROUND
  The role of D-dimer (D-d) as a diagnostic biomarker and its prognostic value in patients with intramural hematoma (IMH) or penetrating aortic ulcer (PAU) are unknown.
  
  
  METHODS
  Clinical data of 231 patients with an acute aortic syndrome (AAS) (159 acute aortic dissection [AAD], 35 IMH and 37 PAU) were collected between 2010 and 2014. D-d was determined at admission and during the hospitalization. D-d measurements in 291 patients admitted to the chest pain unit, in whom AAS was ruled out, were used as control.
  
  
  RESULTS
  Admission D-d was significantly higher in AAD (12.5±11.1 mg/L) and IMH (14.8±12.2 mg/L) compared with PAU (1.8±1.8 mg/L; p=0.007 and p=0.009, respectively). At a cutoff of 0.5 mg/L, D-d showed superior predictive value for AAD and IMH (sensitivity 99% and 100%, respectively; specificity 67% for both), than for PAU (sensitivity 64%, specificity 67%). Both admission and in-hospital D-d were predictive for in-hospital mortality using a cutoff of 9.0 mg/L (area under the curve 0.68 and 0.78; p=0.019 and p=0.009, respectively). On multivariate analysis, in-hospital D-d ⩾9 mg/L (odds ratio [OR] 5.60, p=0.022), mesenteric ischemia/infarction (OR 5.64, p=0.038) and hypotension/shock/tamponade (OR 11.76, p<0.001) were independent predictors of in-hospital mortality. In contrast, at 3-year follow-up D-d levels did not affect survival.
  
  
  CONCLUSIONS
  At a cutoff of 0.5 mg/L, D-d was a reliable diagnostic marker for AAD and IMH, but not for PAU. A mean D-d ⩾9 mg/L during the hospitalization was an independent predictor of in-hospital mortality, but did not affect survival at follow-up.
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.|2 University of Insubria, Varese, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Gorla
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.affiliation: 3 Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tsagakis
authors.affiliation: 3 Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Amir-Abbas
authors.initials: AA
authors.lastname: Mahabadi
authors.affiliation: 4 Department of Radiology, University Hospital Essen and University Duisburg-Essen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlosser
authors.affiliation: 5 Cardioangiological Center Bethanien, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.affiliation: 6 Heart Department, University Hospital, Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany.
authors.forename: Rolf Alexander
authors.initials: RA
authors.lastname: Jánosi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000097:blood / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000097:blood / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055503:Protein Multimerization; D012189:Retrospective Studies; D013577:Syndrome
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Acute aortic dissection; D-dimer; acute aortic syndromes; intramural hematoma; penetrating aortic ulcer