Cor Vasa 2013, 55(6):e510-e514 | DOI: 10.1016/j.crvasa.2013.04.009

Utility of plasma D-dimer levels in the diagnosis of acute aortic dissection

Marian Levčík^a,*, Jiří Kettner^a, Antonín Jabor^b, Josef Kautzner^a

^a Klinika kardiologie, Institut klinické a experimentální medicíny, Praha, Česká republika

^b Pracoviště laboratorních metod, Institut klinické a experimentální medicíny, Praha, Česká republika

Aim: To test the utility of plasma D-dimer determination in the diagnosis of acute aortic dissection (AAD), in particular with respect to its high negative predictive value reported in the relevant literature.

Method: We performed a retrospective analysis of the medical records of 76 patients admitted for acute chest pain of unclear etiology (of this number, 41 AAD patients and 35 controls with undocumented AAD) who had their plasma D-dimer levels determined on admission. Using imaging techniques, AAD was documented in the 41 AAD patients by computer tomography (80%), esophageal echocardiography (18%), aortography or based on pathological anatomical autopsy findings (one patient each).

Results: The finding of increased D-dimer levels (> 0.5 mg/l FEU) showed a 100% sensitivity, i.e., a 100% negative predictive value; 37% specificity, 65% positive predictive value, and 71% accuracy in diagnosing AAD. Elevated D-dimer levels correlated with more extensive involvement of the aorta consistent with the type of dissection using De Bakey's classification (II, III, I; r = 0.63; p < 0.01). No correlation was found between plasma D-dimer levels and chest pain duration.

Conclusion: Determination of plasma D-dimer levels seems to be a useful tool in early diagnosis of AAD. Plasma D-dimer levels < 0.5 mg/l FEU virtually exclude the presence of AAD.

Keywords: Acute aortic dissection; D-dimer; Negative predictive value

Received: March 15, 2013; Revised: April 26, 2013; Accepted: April 28, 2013; Published: December 1, 2013  Show citation