Acute aortic dissection (AD) remains a potentially catastrophic cardiovascular disease. Recent advancements in imaging methods (eg, computed tomography, magnetic resonance imaging) and the development of novel biochemical diagnostic methods (eg, smooth muscle myosin heavy chain) have made improved diagnosis of the disease possible and therefore allowed early and optimized treatment. However, the disease at times remains overlooked or misdiagnosed because of its relatively uncommon nature. Fourteen centres in Europe, the United States, and Japan participated in The International Registry of Acute Aortic Dissection Substudy on Biomarkers (IRAD-Bio) Experience.
The authors found a favourable negative likelihood ratio of 0.07 and negative predictive value of 95% in patients within the first 24 hours of onset at the widely used cutoff level of 500 ng/mL, suggesting that the D-Dimer assay may be useful for ruling out AD in this time window with a diagnostic performance similar to that reported for PE. Time course analysis showed that for patients presenting within the initial 6 hours of symptom onset, a rule-in cutoff level of 1600 ng/mL in this time window identifies patients with a high probability/ likelihood of AD.
Further studies are still needed to clarify the best way to integrate D-Dimer testing in patients with various prior probabilities of acute AD.
Receiver-operating characteristics curves for all patients with acute AD vs all control subjects and each of the control diseases.