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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

View larger version (13K): [in a new window]   Figure 1 Comparison of D-dimer values between the different patient groups (p values adjusted according to Bonferoni). AD = aortic dissection; AMI = acute myocardial infarction; CP = chest pain; PE = pulmonary embolism.

View larger version (13K): [in a new window]   Figure 2 Correlation between D-dimers and time from symptom onset in acute aortic dissection.

View larger version (15K): [in a new window]   Figure 3 Serial D-dimer measurements of four acute aortic dissection patients. In the three surviving patients, serial D-dimer measurements demonstrate a decline over time, while in one patient who died (, 76 years old, ), steady increase was found.

View larger version (17K): [in a new window]   Figure 4 Calculation of optimal cutoff value between acute aortic dissection and other chest-pain syndromes, including pulmonary embolism, by receiver operator characteristic curve analysis with respect to D-dimers. Dotted line shows a random distribution. AUC = area under the receiver operator characteristic curve.

View larger version (14K): [in a new window]   Figure 5 Comparison of white blood cell (WBC) count between the different patient groups (p values adjusted according to Bonferoni). AD = aortic dissection; AMI = acute myocardial infarction; CP = chest pain; PE = pulmonary embolism.

View larger version (13K): [in a new window]   Figure 6 Comparison of C-reactive protein (CRP) values between the different patient groups (p values adjusted according to Bonferoni). AD = aortic dissection; AMI = acute myocardial infarction; CP = chest pain; PE = pulmonary embolism.

View larger version (14K): [in a new window]   Figure 7 Comparison of fibrinogen values between the different patient groups (p values adjusted according to Bonferoni). AD = aortic dissection; AMI = acute myocardial infarction; CP = chest pain; PE = pulmonary embolism.