Published Online
on May 11, 2009

A more recent version of this article appeared on May 26, 2009

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Submitted on October 31, 2008
Accepted on March 24, 2009

Diagnosis of Acute Aortic Dissection by D-Dimer. The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) Experience

Toru Suzuki MD^*, Alessandro Distante MD, Antonella Zizza MS, Santi Trimarchi MD, Massimo Villani MD, Jorge Antonio Salerno Uriarte MD, Luigi De Luca Tupputi Schinosa MD, Attilio Renzulli MD, Federico Sabino MD, Richard Nowak MD, Robert Birkhahn MD, Judd E. Hollander MD, Francis Counselman MD, Ravi Vijayendran PhD, Eduardo Bossone MD, Kim Eagle MD, for the IRAD-Bio Investigators

From the University of Tokyo, Tokyo, Japan (T.S.); Istituto Scientifico Biomedico Euro Mediterraneo, Brindisi, Institute of Clinical Physiology, National Research Council, Lecce, and University Medical School, Pisa, Italy (A.D.); Institute of Clinical Physiology, National Research Council, Lecce, Italy (A.Z.); IRCCS Policlinico San Donato, Milan, Italy (S.T.); Vito Fazzi Hospital, Lecce, Italy (M.V.); Universita degli studi dell'Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy (J.A.S.U.); Policlinico Hospital, Bari, Italy (L.D.L.T.S.); UMG, Catanzaro, Italy (A.R.); ALIV Healthcare R&D, Forte dei Marmi, Italy (F.S.); Henry Ford Hospital, Detroit, Mich (R.N.); New York Methodist Hospital, Brooklyn (R.B.); University of Pennsylvania, Philadelphia (J.E.H.); Eastern Virginia Medical School, Norfolk (F.C.); Biosite, San Diego, Calif (R.V.); National Research Council, Lecce, Italy (E.B.); and University of Michigan, Ann Arbor (K.E.).

^* To whom correspondence should be addressed. E-mail: torusuzu-tky{at}umin.ac.jp.

Background—D-dimer has been reported to be elevated in acute aortic dissection. Potential use as a "rule-out" marker has been suggested, but concerns remain given that it is elevated in other acute chest diseases, including pulmonary embolism and ischemic heart disease. We evaluated the diagnostic performance of D-dimer testing in a study population of patients with suspected aortic dissection.

Methods and Results—In this prospective multicenter study, 220 patients with initial suspicion of having acute aortic dissection were enrolled, of whom 87 were diagnosed with acute aortic dissection and 133 with other final diagnoses, including myocardial infarction, angina, pulmonary embolism, and other uncertain diagnoses. D-dimer was markedly elevated in patients with acute aortic dissection. Analysis according to control disease, type of dissection, and time course showed that the widely used cutoff level of 500 ng/mL for ruling out pulmonary embolism also can reliably rule out aortic dissection, with a negative likelihood ratio of 0.07 throughout the first 24 hours.

Conclusion—D-dimer levels may be useful in risk stratifying patients with suspected aortic dissection to rule out aortic dissection if used within the first 24 hours after symptom onset.

Key words: aorta • diagnosis • peripheral vascular disease

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Clinical Summaries
Circulation 2009 119: 2645-2646. [Extract] [Full Text]

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