Using fibrin degradation products level to facilitate diagnostic evaluation of potential acute aortic dissection

Abstract

This study evaluated whether degradation products of plasma fibrin and fibrinogen (FDP) level can be used to differentiate acute aortic dissection (AAD) from acute myocardial infarction (AMI), angina pectoris, acute cerebral infarction, or transient cerebral ischemic attack (TIA). Ninety-six consecutive patients with definitive diagnosis of AAD by contrast-enhanced computed tomography scan underwent measurement of FDP on admission. Of these patients, 45 had a patent false lumen (patent-type), and 51 had complete thrombosis of the false lumen (thrombosed-type). Control groups were patients admitted during the same period for whom a diagnosis of either AMI (n = 187), angina pectoris (n = 142), cerebral infarction (n = 353), or TIA (n = 94) was confirmed. FDP was significantly higher in patients with patent-type AAD (median, 210 μg/mL; interquartile range, 70-358 μg/mL) than in those with thrombosed-type AAD (16.5, 7.2-50.1). Patients with patent-type AAD or thrombosed-type AAD had a significantly higher FDP than patients in any of the control groups. Receiver operating characteristic curve analysis indicated that FDP ≥ 12.6 μg/mL was the cutoff value that best differentiated patients with patent-type AAD from patients in any of the control groups (sensitivity, 100%; negative predictive value [NPV], 100%). And, this FDP cutoff level was associated with a high positive predictive value (PPV) (80-92%). The cutoff value to differentiate patients with thrombosed-type AAD from patients in any of the control groups was FDP ≥ 5.6 μg/mL (sensitivity, 100%; NPV, 100%). However, this FDP cutoff level was associated with a low PPV (36-81%). FDP and D-dimer were measured at the same time on admission in 30 patients with AAD and 41 patients in control groups. A simple liner regression, calculated using FDP and D-dimer values from a total of 71 patients, yielded a correlation coefficient (R2) of 0.95, indicating a strong correlation. In symptomatic patients with suspected AAD, a diagnosis of patent-type AAD should be considered if FDP ≥ 12.6 μg/mL. Patients with FDP ≥ 5.6 μg/mL have the possibility of thrombosed-type AAD.