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AORTIC DISSECTION

Value of plasma fibrin D-dimers for detection of acute aortic dissection

Holger Eggebrecht, MD^*,*, Christoph K. Naber, MD^*, Christian Bruch, MD, Knut Kröger, MD, Clemens von Birgelen, MD, PhD^||, Axel Schmermund, MD^*, Marc Wichert, MD, Thomas Bartel, MD^*, Klaus Mann, MD and Raimund Erbel, MD, FACC^*

^* Department of Cardiology
Department of Angiology
Department of Clinical Chemistry, West-German Heart Center Essen, University of Duisburg-Essen, Essen, Germany
Department of Cardiology and Angiology, University of Münster, Münster, Germany
^|| Department of Cardiology, Medisch Spectrum Twente, Enschede, the Netherlands

Manuscript received March 13, 2004; revised manuscript received April 13, 2004, accepted April 20, 2004.

^* Reprint requests and correspondence: Dr. Holger Eggebrecht, Department of Cardiology, University of Duisburg-Essen, Hufelandstrasse 55, 45122 Essen, Germany (Email: holger.eggebrecht{at}uni-essen.de).

OBJECTIVES: The purpose of this research was to assess the value of systemic inflammatory biomarkers in the detection of acute aortic dissection (AD).

BACKGROUND: Rapid diagnosis and initiation of treatment is pivotal for patients with acute AD. So far, there is no laboratory test to aid the diagnosis.

METHODS: Plasma fibrin D-dimers, white blood cell (WBC) count, C-reactive protein (CRP), and fibrinogen were determined in 64 chest-pain (CP) patients (acute AD, n = 16; pulmonary embolism [PE], n = 16; acute myocardial infarction [AMI], n = 16; non-cardiac CP, n = 16); 32 asymptomatic patients with chronic AD served as a control group.

RESULTS: All acute AD patients showed highly elevated D-dimer values that were similar to PE patients (2,238 ± 1,765 µg/l vs. 1,531 ± 837 µg/l, p = 0.15) but significantly higher than in chronic AD, AMI, or CP patients (p < 0.001). The WBC count was significantly increased in patients with acute AD compared with the other groups (p < 0.001); in addition, CRP values differed only non-significantly from PE patients(p = 0.71). There were no differences in the fibrinogen levels between the groups.

CONCLUSIONS: D-dimers are highly elevated in both acute PE and acute AD. Patients with acute AD show significant systemic inflammatory reactions. Measurement of D-dimers may be a valuable addition to the current diagnostic work-up of patients with suspected AD.

Abbreviations and Acronyms   AD = aortic dissection   AMI = acute myocardial infarction   CP = chest pain   CRP = C-reactive protein   CT = computed tomography   FL = false lumen   PE = pulmonary embolism   WBC = white blood cell

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