Abstract 19096: D-dimer Profile and Prognostic Implication in Different Classes of Acute Aortic Syndromes

Abstract

Background: D-dimer has been reported to be elevated at presentation in acute aortic dissection (AAD). However, little is known about D-dimer in the setting of intramural hematoma (IMH) and penetrating aortic ulcer (PAU) as well as its time course during hospitalization. Methods: Clinical and laboratory data of 300 patients with acute aortic syndromes (208 AAD, 45 IMH and 47 PAU) were prospectively collected from 2000 to 2014. D-dimer blood levels were measured at presentation and daily during hospitalization with a latex-enhanced turbidometric test (250 μg/l upper limit of normal; D-dimer Plus - Dade Behring) until 2009 and with a microparticle-enhanced immunoassay (0,55 mg/l upper limit of normal; Innovance - Dade Behring) from 2010. Analysis of variance with Bonferroni post hoc analysis and Student T test were applied as appropriate. Results: At presentation, AAD and IMH showed significantly higher D-dimer levels than PAU (p<0,01). Similarly, D-dimer levels during hospitalization were found significantly higher in AAD and IMH, as compared to PAU (p<0,001). From a subgroup analysis according to in-hospital outcome, D-dimer levels were significantly increased in patients complicated with major adverse events (a composite of extension/new dissection, aortic rupture and death) as compared to others (n=86, 29% and n=214, 71%; D-dimer: 1432 ± 855 μg/l vs. 787 ± 215 μg/l, p<0,001; 10,5 ± 6,3 mg/l vs. 8,3 ± 2,1 mg/l, p<0,05 respectively). (Table 1) Conclusions: D-dimer levels were found markedly increased both at presentation and during hospitalization in AAD and IMH, but not in PAU. Interestingly, higher values during hospital stay were associated with in-hospital major adverse events. Further studies are needed to integrate D-dimer testing in AAS clinical diagnostic and prognostic risk stratification scoring tools.