Evaluation of D-Dimer as a Diagnostic Tool in Patients with Acute Aortic Dissection

Tarek Bishay,Samir Rafla

doi:10.4236/wjcd.2021.112015

Abstract

Acute (Ac.) Aortic Dissection (AD) is a life threatening cardiovascular emergency. The diagnostic methods (e.g., TEE, MRI, Multislice CT) are limited by availability. A fast, cost effective and technically simple method for diagnosis of AAD is needed. D-Dimer is a measure of clot formation and lysis. The aim of this study was to determine whether assessing D-Dimer level can be used for the diagnosis of AAD. Methods: 45 patients with clinical suspicion of AAD who presented within the first 24 hours from symptom onset were studied prospectively. 20 patients were proved to have AAD by TEE (group I). The other 25 patients had other final diagnosis (group II). All the 20 patients in group I (100%) with confirmed AAD had positive and elevated D-Dimer levels while only 9 patients in group II (36%) had positive D-Dimer levels (p Conclusion: D-Dimer levels are positive and elevated in all the patients with AAD presenting within the first 24 hours from symptom onset.

Highlights

AAD is a life threatening cardiovascular emergency with a mortality rate of 1% 2% per hour [1]
Mean D-Dimer level was significantly higher in Stanford type A, AAD than in Stanford type B, AAD, (p < 0.01). 5 patients (25%) died during the in–hospital course
Exclusion criteria: 1) Patients with Intramural Hematoma (IMH)

Summary

Introduction

AAD is a life threatening cardiovascular emergency with a mortality rate of 1% 2% per hour [1]. AAD, if not diagnosed early is frequently fatal [2]. Because the clinical manifestations of AD are diverse, the clinical presentation may be similar to manifestations of other diseases [3]. Since almost 20% of patients may present without pain and with non-major symptoms like syncope, cerebrovascular accidents or with congestive heart failure, evaluation of patients with suspicion of AAD is often difficult [1] [4]. The main challenge in managing AAD is to diagnose the disease as early as possible. The choice of initial imaging modality depends on availability preference. The newer and preferred diagnostic methods (e.g., TEE, Multislice CT) are still limited by availability. The patients may be hemodynamically unstable for performing these methods [5]

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Discussion

Conclusion