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Han X, Wang S, Cai R, Chen Q, Li J, Zhong L, Ji S, Mei X, Wu R, Yan Y, Lv Y, Zhang Z. The combined use of serum Raman spectroscopy and D dimer testing for the early diagnosis of acute aortic dissection. Heliyon 2024; 10:e32474. [PMID: 39183889 PMCID: PMC11341313 DOI: 10.1016/j.heliyon.2024.e32474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 08/27/2024] Open
Abstract
Objectives Acute aortic dissection (AAD) is an extremely life-threatening medical emergency, often misdiagnosed in its early stages, resulting in prolonged wait times for rescue. This study aims to identify potential serum biomarkers that can assist in the accurate diagnosis of AAD and effectively differentiate it from other conditions causing severe chest pain. Methods A total of 122 patients with AAD and 129 patients with other severe chest pain disorders were included in the study. Serum samples were analyzed by measuring the peak intensities of Raman spectra. For each measurement, the Raman spectrum was accumulated by two accumulations (3 s per acquisition). Logistic regression and nomogram models were developed using these peak intensities as well as D-dimer levels to predict the occurrence of AAD. The clinical utilities of these models were assessed through receiver operating characteristics (ROC) curve analysis, net reclassification improvement (NRI), integrated discrimination improvement (IDI), and decision curve analysis (DCA) in both training and internal test cohorts. Results The D-dimer levels of AAD patients were significantly increased, as well as higher intensities at specific Raman peaks, including 505 cm-1, 842 cm-1, 947 cm-1, 1254 cm-1, 1448 cm-1, and 1655 cm-1 when compared to non-AAD patients. Conversely, decreased intensities were observed at Raman peaks such as 750 cm-1, 1004 cm-1, 1153 cm-1, 1208 cm-1, and 1514 cm-1 in AAD patients. Least absolute shrinkage and selection operator regression analysis on the training cohort identified eight potential predictors: D-dimer along with intensity measurements at peaks such as 505 cm-1, 750 cm-1, 1153 cm-1, 1208 cm-1, 1254 cm-1, 1448 cm-1, and 1655 cm-1. The combination of these eight potential predictors demonstrated a good discriminatory performance, with an area under the curve (AUC) value of 0.928 in the training cohort and an AUC of 0.936 in the internal test cohort, outperforming the use of D-dimer alone. Furthermore, DCA curve analysis revealed that leveraging this combination of eight potential predictors would provide substantial net benefits for clinical application. Moreover, this combination significantly augmented discrimination power, as evidenced by a continuous NRI of 39.8 % and IDI of 9.95 % in the training cohort, as well as a continuous NRI of 27.1 % and IDI of 9.95 % in the internal test cohort. Conclusions The employment of this combination of eight potential predictors effectively rules out AAD to a greater extent. This study presents a promising diagnostic strategy for early detection using optical diagnostic techniques such as Raman spectroscopy.
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Affiliation(s)
- Xuechang Han
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Anesthesiology, The First Affiliated Hospital and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Shuang Wang
- Institute of Photonics and Photon-Technology, Northwest University, Xi'an, China
| | - Runlu Cai
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qiang Chen
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liang Zhong
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuman Ji
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaopeng Mei
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Rongqian Wu
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yang Yan
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yi Lv
- National Local Joint Engineering Research Center for Precision Surgery & Regenerative Medicine, Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhanqin Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Essat M, Goodacre S, Pandor A, Ren S, Ren S, Clowes M. Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes: Systematic Review and Meta-Analysis. Ann Emerg Med 2024:S0196-0644(24)00260-9. [PMID: 38888529 DOI: 10.1016/j.annemergmed.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/28/2024] [Accepted: 05/01/2024] [Indexed: 06/20/2024]
Abstract
STUDY OBJECTIVE Acute aortic syndrome is a life-threatening emergency condition. Previous systematic reviews of D-dimer diagnostic accuracy for acute aortic syndrome have been contradictory and based on limited data, but recently published studies offer potential for a more definitive overview. We aimed to perform a systematic review and meta-analysis to determine the diagnostic accuracy of D-dimer for diagnosing acute aortic syndrome. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library from inception to February 2024. Additionally, the reference lists of included studies and other systematic reviews were thoroughly searched. All diagnostic cohort studies (prospective or retrospective) that assessed the use of D-dimer for diagnosing acute aortic syndrome compared with a reference standard test (eg, computed tomographic angiography (CTA), ECG-gated CTA, echocardiography, magnetic resonance angiography, operation, or autopsy) were included. Two independent reviewers completed study selection, data extractions and quality assessment using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Data were synthesized using a bivariate meta-analysis model. RESULTS Of 2017 potentially relevant citations, 25 cohort studies met the inclusion criteria, and 18 reporting the 500 ng/mL threshold were included in the primary meta-analysis. Risk of bias domains were mostly unclear due to limited study reporting. The summary sensitivity was 96.5% (95% credible interval [CrI] 94.8% to 98%) and summary specificity was 56.2% (95% CrI, 48.3% to 63.9%). Study specificity varied markedly from 33% to 86%, indicating substantial heterogeneity. Sensitivity analysis including the 7 studies reporting other thresholds showed summary sensitivity of 95.7% (95% CrI, 93.2% to 97.5%) and summary specificity of 57.5% (95% CrI, 50.1% to 64.6%). CONCLUSION D-dimer concentration has high sensitivity (96.5%) and moderate specificity (56.2%) for acute aortic syndrome, with some uncertainty around estimates due to risk of bias and heterogeneity. Previous meta-analysis reporting higher specificity may be explained by inclusion of case-control studies that may overestimate accuracy.
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Affiliation(s)
- Munira Essat
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Abdullah Pandor
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Sa Ren
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Shijie Ren
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
| | - Mark Clowes
- Sheffield Centre for Health and Related Research, University of Sheffield, Sheffield, UK
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Alshalhoub M, Alhusain F, Alsulaiman F, Alturki A, Aldayel S, Alsalamah M. Clinical significance of elevated D-dimer in emergency department patients: a retrospective single-center analysis. Int J Emerg Med 2024; 17:47. [PMID: 38566042 PMCID: PMC10988841 DOI: 10.1186/s12245-024-00620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION D-dimer is a marker of coagulation and fibrinolysis widely used in clinical practice for assessing thrombotic activity. While it is commonly ordered in the Emergency Department (ED) for suspected venous thromboembolism (VTE), elevated D-dimer levels can occur due to various other disorders. The aim of this study was to find out the causes of elevated D-dimer in patients presenting to a large ED in Saudi Arabia and evaluate the accuracy of D-dimer in diagnosing these conditions. METHODS Data was collected from an electronic hospital information system of patients who visited the ED from January 2016 to December 2022. Demographic information, comorbidities, D-dimer levels, and diagnoses were analyzed. Statistical analysis was performed using the SPSS software. The different diagnoses associated with D-dimer levels were analyzed by plotting the median D-dimer levels for each diagnosis category and their interquartile ranges (IQR). The receiver operating characteristic (ROC) curves were calculated and their area under the curve (AUC) values were demonstrated. The optimal cut-off points for specific diseases were determined based on the ROC analysis, along with their corresponding sensitivities and specificities. RESULTS A total of 19,258 patients with D-dimer results were included in the study. The mean age of the participants was 50 years with a standard deviation of ± 18. Of the patients, 66% were female and 21.2% were aged 65 or above. Additionally, 21% had diabetes mellitus, 20.4% were hypertensive, and 15.1% had been diagnosed with dyslipidemia. The median D-dimer levels varied across different diagnoses, with the highest level observed in aortic aneurysm 5.46 g/L. Pulmonary embolism (PE) and deep vein thrombosis (DVT) were found in 729 patients (3.8%) of our study population and their median D-dimer levels 3.07 g/L (IQR: 1.35-7.05 g/L) and 3.36 g/L (IQR: 1.06-8.38 g/L) respectively. On the other hand, 1767 patients (9.2%) were diagnosed with respiratory infections and 936 patients (4.9%) were diagnosed with shortness of breath (not specified) with median D-dimer levels of 0.76 g/L (IQR: 0.40-1.47 g/L) and 0.51 g/L (IQR: 0.29-1.06 g/L), respectively. D-dimer levels showed superior or excellent discrimination for PE (AUC = 0.844), leukemia (AUC = 0.848), and aortic aneurysm (AUC = 0.963). DVT and aortic dissection demonstrated acceptable discrimination, with AUC values of 0.795 and 0.737, respectively. D-dimer levels in respiratory infections and shortness of breath (not specified) exhibited poor to discriminatory performance. CONCLUSION This is the first paper to identify multiple causes of elevated D-dimer levels in Saudi Arabia population within the ED and it clearly highlights their accurate and diagnostic values. These findings draw attention to the importance of considering the specific clinical context and utilizing additional diagnostic tools when evaluating patients with elevated D-dimer levels.
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Affiliation(s)
- Mohammed Alshalhoub
- Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Faisal Alhusain
- Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Feras Alsulaiman
- Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Alturki
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saud Aldayel
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Majid Alsalamah
- Emergency Medicine Department, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Deng L, Xia Q, Diao L, Lin F, Cao Y, Han H, Song M. Aortic Dissection Detection Risk Score and D-Dimer for Acute Aortic Syndromes in the Chinese Population: Exploration of Optimal Thresholds and Integrated Diagnostic Value. J Cardiovasc Transl Res 2023; 16:886-895. [PMID: 36729356 DOI: 10.1007/s12265-023-10354-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 01/12/2023] [Indexed: 02/03/2023]
Abstract
This study aimed to assess the diagnostic performance of the aortic dissection detection risk score (ADD-RS) plus D-dimer for acute aortic syndrome (AAS) in Chinese patients. Two hundred and sixty-two and 200 patients with suspected AAS symptoms were enrolled as exploration cohort and validation cohort, respectively. In exploration cohort, ADD-RS plus D-dimer (AUC = 0.929, 95%CI: 0.887-0.971) presented a better diagnostic value for AAS than ADD-RS or D-dimer alone. Meanwhile, ADD-RS > 1 and D-dimer > 2000 ng/mL were the optimal thresholds. Then, a diagnostic model integrating ADD-RS > 1 plus D-dimer > 2000 ng/mL was established, presenting sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 92.5%, 70.3%, 34.9%, and 98.2%, respectively. In validation cohort, the established diagnostic model exhibited a sensitivity, specificity, PPV, and NPV of 93.1%, 70.2%, 34.6%, and 98.4%, respectively, for diagnosing AAS. Summarily, ADD-RS > 1 and D-dimer > 2000 ng/mL are optimal thresholds for diagnosing AAS in the Chinese population. However, confirmative MSCT results are necessary.
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Affiliation(s)
- Li Deng
- Department of Extracorporeal Life Support, The People's Hospital of Gaozhou, Gaozhou, 525200, China
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, China
| | - Qingping Xia
- Department of Science and Education, The People's Hospital of Gaozhou, Gaozhou, 525200, China
| | - Liwei Diao
- Department of Cardiothoracic Surgery, University of Chinese Academy of Sciences Shenzhen Hospital, Shenzhen, 518000, China
| | - Fei Lin
- Department of Extracorporeal Life Support, The People's Hospital of Gaozhou, Gaozhou, 525200, China
| | - Yong Cao
- Department of Cardiovascular Surgery, The People's Hospital of Gaozhou, Gaozhou, 525200, China
| | - Hongguang Han
- Shuren International College of Shenyang Medical College, 146 Huanghe North Street, Shenyang, 110000, Liaoning, China.
| | - Mowei Song
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng St, Harbin, 150001, China.
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Chen J, Bai Y, Liu H, Qin M, Guo Z. Prediction of in-hospital death following acute type A aortic dissection. Front Public Health 2023; 11:1143160. [PMID: 37064704 PMCID: PMC10090540 DOI: 10.3389/fpubh.2023.1143160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundOur goal was to create a prediction model for in-hospital death in Chinese patients with acute type A aortic dissection (ATAAD).MethodsA retrospective derivation cohort was made up of 340 patients with ATAAD from Tianjin, and the retrospective validation cohort was made up of 153 patients with ATAAD from Nanjing. For variable selection, we used least absolute shrinkage and selection operator analysis, and for risk scoring, we used logistic regression coefficients. We categorized the patients into low-, middle-, and high-risk groups and looked into the correlation with in-hospital fatalities. We established a risk classifier based on independent baseline data using a multivariable logistic model. The prediction performance was determined based on the receiver operating characteristic curve (ROC). Individualized clinical decision-making was conducted by weighing the net benefit in each patient by decision curve analysis (DCA).ResultsWe created a risk prediction model using risk scores weighted by five preoperatively chosen variables [AUC: 0.7039 (95% CI, 0.643–0.765)]: serum creatinine (Scr), D-dimer, white blood cell (WBC) count, coronary heart disease (CHD), and blood urea nitrogen (BUN). Following that, we categorized the cohort's patients as low-, intermediate-, and high-risk groups. The intermediate- and high-risk groups significantly increased hospital death rates compared to the low-risk group [adjusted OR: 3.973 (95% CI, 1.496–10.552), P < 0.01; 8.280 (95% CI, 3.054–22.448), P < 0.01, respectively). The risk score classifier exhibited better prediction ability than the triple-risk categories classifier [AUC: 0.7039 (95% CI, 0.6425–0.7652) vs. 0.6605 (95% CI, 0.6013–0.7197); P = 0.0022]. The DCA showed relatively good performance for the model in terms of clinical application if the threshold probability in the clinical decision was more than 10%.ConclusionA risk classifier is an effective strategy for predicting in-hospital death in patients with ATAAD, but it might be affected by the small number of participants.
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Affiliation(s)
- Junquan Chen
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Yunpeng Bai
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
| | - Hong Liu
- Department of Cardiovascular Surgery, First Hospital of Nanjing Medical University, Nanjing, China
| | - Mingzhen Qin
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
| | - Zhigang Guo
- Department of Cardiovascular Surgery, Tianjin Chest Hospital, Tianjin, China
- *Correspondence: Zhigang Guo
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Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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8
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Zitek T, Hashemi M, Zagroba S, Slane VH. A Retrospective Analysis of Serum D-Dimer Levels for the Exclusion of Acute Aortic Dissection. Open Access Emerg Med 2022; 14:367-373. [PMID: 35924032 PMCID: PMC9342875 DOI: 10.2147/oaem.s373335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Acute aortic dissection (AAD) is a highly fatal disorder if not promptly diagnosed. Some international studies have suggested that serum d-dimer levels may be used to exclude AAD, but data are limited. We sought to confirm that d-dimer levels are elevated in American patients with AAD. Additionally, we sought to estimate the test characteristics of the d-dimer for AAD. Patients and Methods We performed a retrospective analysis of patients in the Hospital Corporation of America database who arrived at the hospital between 2015 and 2019. We queried the database to find patients who had a diagnosis of AAD or (nonspecific) chest pain, and who also had a d-dimer performed within 24 hours of arrival at the hospital. The median d-dimer was compared in those diagnosed with AAD versus chest pain. We estimated the test characteristics of d-dimer for AAD at the standard cutoff value of 500 ng/mL. Results In total, 48,902 patients met the criteria for analysis, including 572 with AAD and 48,330 with chest pain. The median d-dimers were 2455 ng/mL and 385 ng/mL for the AAD and chest pain groups, respectively (p < 0.0001). Using a cutoff of 500 ng/mL, the sensitivity of the d-dimer was 91.1% and the specificity was 71.4%. Conclusion Serum d-dimer values are higher in patients with AAD than in those with nonspecific chest pain. At the standard cutoff of 500 ng/mL, the serum d-dimer has a high sensitivity for AAD, but not high enough that d-dimer levels alone can be used in isolation to exclude AAD.
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Affiliation(s)
- Tony Zitek
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
- Correspondence: Tony Zitek, Department of Emergency Medicine, Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL, 33140, USA, Tel +1-305-674-2121 Ext 56632, Email
| | - Mani Hashemi
- Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USA
| | - Sara Zagroba
- Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USA
| | - Valori H Slane
- Department of Emergency Medicine, Kendall Regional Medical Center, Miami, FL, USA
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Madlener M, Onur OA, Müller-Ehmsen J, Fink GR, Burghaus L. [Acute Aortic Dissection: A Life-Threatening Disease Also in Neurological Emergency Medicine]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2022; 90:571-579. [PMID: 35508194 DOI: 10.1055/a-1802-3852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Acute aortic dissection is rare but life-threatening. The symptoms depend on the localization and reduced perfusion of the downstream organs or limbs and are therefore variable. Neurological symptoms may occur that do not immediately lead to a diagnosis and thus delay the necessary therapy. Knowing the early symptoms and warning signs of aortic dissection is therefore also crucial in neurological emergency care for quickly identifying the affected patients and for providing acute therapy. A misdiagnosis with delayed initiation of therapy can significantly worsen the patient's outcome. This study aims to establish a standardized diagnostic and therapeutic algorithm for suspected acute aortic dissection in neurological emergency care. Close interdisciplinary cooperation is mandatory.
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Affiliation(s)
- Marie Madlener
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany
| | - Oezguer A Onur
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany
| | | | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany.,Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Lothar Burghaus
- Klinik und Poliklinik für Neurologie, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Köln, Germany.,Klinik für Neurologie, Heilig Geist-Krankenhaus Köln, Köln, Germany
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10
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Yang S, Xiao Y, Du Y, Chen J, Ni Q, Guo X, Xue G, Xie X. Diagnostic and Prognostic Value of Neutrophil Extracellular Trap Levels in Patients With Acute Aortic Dissection. Front Cardiovasc Med 2022; 8:683445. [PMID: 35242817 PMCID: PMC8885526 DOI: 10.3389/fcvm.2021.683445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Acute aortic dissection (AAD) is a fatal disease demanding prompt diagnosis and proper treatment. There is a lack of serum markers that can effectively assist diagnosis and predict prognosis of AAD patients. Methods Ninety-six AAD patients were enrolled in this study, and 249 patients with chest pain due to acute myocardial infarction, pulmonary embolism, intramural hematoma, angina or other causes and 80 healthy controls were included as control group and healthy control group. Demographics, biochemical and hematological data and risk factors were recorded as baseline characteristics. The 1-year follow-up data were collected and analyzed. The diagnostic performance and ability to predict disease severity and prognosis of NET components in serum and aortic tissue were evaluated. Results Circulating NET markers, citH3 (citrullination of histone 3), cell-free DNA (cfDNA) and nucleosomes, had good diagnostic value for AAD, with superior diagnostic performance to D-dimer in discriminating patients with chest pain due to other reasons in the emergency department. Circulating NET marker levels (i.e., citH3, cfDNA and nucleosomes) of AAD patients were significantly higher than that of control group and healthy control group. In addition, circulating NET markers levels were closely associated with the disease severity, in-hospital death and 1-year survival of AAD patients. Systolic blood pressure < 90 mmHg and serum citH3 levels were identified as independent risk factors for 1-year survival of AAD patients. Excessive NET components (i.e., neutrophil elastase and citH3) in the aortic tissue of AAD patient were significantly higher than that of healthy donor aortic tissue. The expression levels of granules and nuclear NET components were significantly higher in aortic tissue from AAD patients than controls. Conclusions Circulating NET markers, citH3, cfDNA and nucleosomes, have significant diagnostic value and predictive value of disease severity and prognosis of AAD patients. The NETs components may constitute a useful diagnostic and prognostic marker in AAD patients.
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Affiliation(s)
- Shuofei Yang
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yongsheng Xiao
- Department of Vascular Surgery, Tianjin 4th Centre Hospital, The Fourth Central Hospital Affiliated to Nankai University, The Fourth Center Clinical College of Tianjin Medical University, Tianjin, China
| | - Yuanfeng Du
- Department of Neurosurgery, School of Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University, Hangzhou, China
| | - Jiaquan Chen
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qihong Ni
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiangjiang Guo
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guanhua Xue
- Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- *Correspondence: Guanhua Xue
| | - Xupin Xie
- Department of Vascular Surgery, School of Medicine, Affiliated Hangzhou First People's Hospital, Zhejiang University, Hangzhou, China
- Xupin Xie
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11
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Yao J, Bai T, Yang B, Sun L. The diagnostic value of D-dimer in acute aortic dissection: a meta-analysis. J Cardiothorac Surg 2021; 16:343. [PMID: 34838062 PMCID: PMC8627055 DOI: 10.1186/s13019-021-01726-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 11/12/2021] [Indexed: 12/26/2022] Open
Abstract
Objective This study aims to evaluate the diagnostic value of D-dimer for acute aortic dissection (AAD) by the method of meta-analysis. Methods PubMed, Cochrane Library, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases from the establishment of the databases to December 2020 were systematically searched, and the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) system was used to evaluate the quality of the literature. STATA 15.0 software was applied to calculate the pooled sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (+LR), negative likelihood ratio (−LR) to draw summary receiver operating characteristics (SROC) curve and calculate the area under the curve (AUC). Meta-regression and subgroup analyses were used to explore the source of heterogeneity. Results A total of 16 clinical studies were enrolled in this study, including 1135 patients. The results of the meta-analysis showed that the pooled sensitivity was 0.96 (95% CI 0.91–0.98), the pooled specificity was 0.70 (95% CI 0.57–0.81), and the pooled DOR was 56.57 (95% CI 25.11–127.44), the pooled +LR was 3.25 (95% CI 2.18–4.85), the pooled −LR was 0.06 (95% CI 0.03–0.12), and the AUC was 0.94 (95% CI 0.91–0.95). Meta-regression and subgroup analysis results showed that publication year, sample size and cutoff value might be sources of heterogeneity. When the concentration of D-dimer was less than or equal to 500 ng/ml, the sensitivity significantly increased. Conclusion D-dimer has an excellent diagnostic value for AAD. It is a useful tool for detecting suspected AAD because of the excellent pooled sensitivity. D-dimer ≤ 500 ng/ml increases the potential to identify the suspected patients with AAD.
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Affiliation(s)
- Jian Yao
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Tao Bai
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Bo Yang
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University and Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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12
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Association of biomarkers related to preoperative inflammatory and coagulation with postoperative in-hospital deaths in patients with type A acute aortic dissection. Sci Rep 2021; 11:18775. [PMID: 34548604 PMCID: PMC8455536 DOI: 10.1038/s41598-021-98298-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/06/2021] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to analyze the role of blood biomarkers regarding preoperative inflammation and coagulation in predicting the postoperative in-hospital mortality of patients with type A acute aortic dissection (AAD). A total of 206 patients with type A AAD who had received surgical treatment were enrolled in this study. Patients were divided into two groups: the death group (28 patients who died during hospitalization) and the survival group (178 patients). Peripheral blood samples were collected before anesthesia induction. Preoperative levels of D-dimer, fibrinogen (FIB), platelet (PLT), white blood cells (WBC) and neutrophil (NEU) were compared between the two groups. Univariable and multivariable logistic regression analysis were utilized to identify the independent risk factors for postoperative in-hospital deaths of patients with type A AAD. Receiver operating characteristic (ROC) curve were used to analyze the predictive value of these indices in the postoperative in-hospital mortality of the patients. Univariable logistic regression analysis showed that the P values of the five parameters including D-dimer, FIB, PLT, WBC and NEU were all less than 0.1, which may be risk factors for postoperative in-hospital deaths of patients with type A AAD. Further multivariable logistic regression analysis indicated that higher preoperative D-dimer and WBC levels were independent risk factors for postoperative in-hospital mortality of patients with type A AAD. ROC curve analysis indicated that application of combining FIB and PLT could improve accuracy in prediction of postoperative in-hospital mortality in patients with type A AAD. Both preoperative D-dimer and WBC in patients with type A AAD may be used as independent risk factors for the postoperative in-hospital mortality of such patients. The combination of FIB and PLT may improve the accuracy of clinical prognostic assessment.
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13
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Koch V, Biener M, Müller-Hennessen M, Vafaie M, Staudacher I, Katus HA, Giannitsis E. Diagnostic performance of D-dimer in predicting venous thromboembolism and acute aortic dissection. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2021; 10:559–566. [PMID: 32186398 PMCID: PMC8248847 DOI: 10.1177/2048872620907322] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/29/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND D-dimer is elevated in a variety of conditions. The purpose of this study was to assess the positive predictive value of D-dimer to rule in patients with confirmed pulmonary embolism, deep vein thrombosis, acute aortic dissection or thrombosis of the upper extremity in comparison to patients with elevated D-dimer for other reasons. METHODS AND RESULTS We studied 1334 patients presenting to the emergency department with pulmonary embolism (n=193), deep vein thrombosis (n=73), acute aortic dissection (n=22), thrombosis of the upper extremity (n=8) and 1038 controls. The positive predictive value was increased with higher D-dimer concentrations improving the ability to identify diseases with high thrombus burden. Patients with venous thromboembolism, acute aortic dissection and thrombosis of the upper extremity showed a maximum positive predictive value of 85.2% at a D-dimer level of 7.8 mg/L (95% confidence interval (CI) 78.1 to 90.4). The maximum positive predictive value was lower in cancer patients with venous thromboembolism, acute aortic dissection and thrombosis of the upper extremity, reaching 68.9% at a D-dimer level of 7.5 mg/L (95% CI 57.4 to 78.4). The positive likelihood ratio was very consistent with the positive predictive value. Using a cut-off level of 0.5 mg/L, D-dimer showed a high sensitivity of at least 93%, but a very low specificity of nearly 0%. Conversely, an optimised cut-off value of 4.6 mg/L increased specificity to 95% for the detection of life-threatening venous thromboembolism, acute aortic dissection or thrombosis of the upper extremity at the costs of moderate sensitivities (58% for pulmonary embolism, 41% for deep vein thrombosis, 65% for pulmonary embolism with co-existent deep vein thrombosis, 50% for acute aortic dissection and 13% for thrombosis of the upper extremity). Using the same cut-off in cancer patients, higher values were observed for sensitivity at a specificity level of more than 95%. The area under the curve for the discrimination of venous thromboembolism/acute aortic dissection/thrombosis of the upper extremity from controls was significantly higher in cancer versus non-cancer patients (area under the curve 0.905 in cancer patients, 95% CI 0.89 to 0.92, vs. area under the curve 0.857 in non-cancer patients, 95% CI 0.84 to 0.88; P=0.0349). CONCLUSION D-dimers are useful not only to rule out but also to rule in venous thromboembolism and acute aortic dissection with an at least moderate discriminatory ability, both in patients with and without cancer.
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Affiliation(s)
- Vitali Koch
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Germany
| | - Moritz Biener
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Germany
| | - Matthias Müller-Hennessen
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Germany
| | - Mershad Vafaie
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Germany
| | - Ingo Staudacher
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Germany
| | - Evangelos Giannitsis
- Department of Internal Medicine III, Cardiology, Angiology and Pulmonology, Heidelberg University Hospital, Germany
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14
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Liu L, Tan S, Li Y, Luo J, Zhang W, Li S. An early aortic dissection screening model and applied research based on ensemble learning. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1578. [PMID: 33437777 PMCID: PMC7791246 DOI: 10.21037/atm-20-1475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background As a particularly dangerous and rare cardiovascular disease, aortic dissection (AD) is characterized by complex and diverse symptoms and signs. In the early stage, the rate of misdiagnosis and missed diagnosis is relatively high. This study aimed to use machine learning technology to establish a fast and accurate screening model that requires only patients' routine examination data as input to obtain predictive results. Methods A retrospective analysis of the examination data and diagnosis results of 53,213 patients with cardiovascular disease was conducted. Among these samples, 802 samples had AD. Forty-two features were extracted from the patients' routine examination data to establish a prediction model. There were five ensemble learning models applied to explore the possibility of using machine learning methods to build screening models for AD, including AdaBoost, XGBoost, SmoteBagging, EasyEnsemble and XGBF. Among these, XGBF is an ensemble learning model that we propose to deal with the imbalance of the positive and negative samples. The seven-fold cross validation method was used to analyze and verify the performance of each model. Due to the imbalance of the samples, the evaluation indicators were sensitivity and specificity. Results Comparative experiments showed that the sensitivity of XGBF was 80.5%, which was better than the 16.1% of AdaBoost, 15.7% of XGBoost, 78.0% of SmoteBagging and 77.8% of EasyEnsemble. Additionally, XGBF had relatively high specificity, and the training time consumption was short. Based on these three indicators, XGBF performed best, and met the application requirements, which means through careful design, we can use machine learning technology to achieve early AD screening. Conclusions Through reasonable design, the ensemble learning method can be used to build an effective screening model. The XGBF has high practical application value for screening for AD.
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Affiliation(s)
- Lijue Liu
- School Of Information Science And Engineering, Central South University, Changsha, China.,Hunan ZIXING Artificial Intelligence Research Institute, Changsha, China
| | - Shiyang Tan
- School Of Information Science And Engineering, Central South University, Changsha, China
| | - Yi Li
- School Of Information Science And Engineering, Central South University, Changsha, China.,Hunan ZIXING Artificial Intelligence Research Institute, Changsha, China
| | - Jingmin Luo
- Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhang
- Xiangya Hospital, Central South University, Changsha, China
| | - Shihao Li
- School Of Information Science And Engineering, Central South University, Changsha, China
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15
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Luo E, Wang D, Liu B, Hou J, Yan G, Tang C. The Value of d-Dimer Level in Predicting Contrast-Induced Acute Kidney Injury in Patients With Acute ST-Segment Elevation Myocardial Infarction After PCI. Clin Appl Thromb Hemost 2020; 26:1076029620944492. [PMID: 33032448 PMCID: PMC7549155 DOI: 10.1177/1076029620944492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) is a serious complication of
percutaneous coronary intervention (PCI) in patients with acute ST-segment
elevation myocardial infarction (STEMI). Early identification of high-risk
patients has an essential role in preventing CI-AKI. This study was designed to
evaluate the predictive value of d-dimer, a marker of thrombosis and
hypercoagulable state, for CI-AKI and prognosis in patients with STEMI. We
included 400 patients with STEMI who underwent PCI. The patients were subdivided
into 4 groups according to d-dimer level using the 4-quantile method.
Contrast-induced acute kidney injury occurred in 66 (16.5%) patients. The
incidence of CI-AKI in the highest quartile of the d-dimer groups
(29.0%) was higher than that in the other 3 groups. Multivariable logistic
regression showed that a low d-dimer level was significantly associated
with a decreased risk of CI-AKI independent of confounding factors, with an odds
ratio (OR) of 0.487 (95% CI: 0.178-0.931, P = 0.041) for those
in the first quartile compared with those in the highest quartile. Age (OR:
1.047, 95% CI: 1.003-1.092), diabetes mellitus (OR: 5.896, 95% CI:
2.496-13.927), anemia (OR: 3.488, 95% CI: 1.308-9.306), and total bilirubin (OR:
0.946, 95% CI: 0.904-0.992) were independent predictors of CI-AKI. The incidence
of major adverse cardiovascular and cerebral events and all-cause mortality
within 30 days, 6 months, and 1 year after PCI in the highest quartile of the
d-dimer groups were higher than those in the other 3 groups. In
conclusion, increasing d-dimer levels were independently associated
with the incidence of CI-AKI and adverse outcomes in patients with STEMI after
PCI.
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Affiliation(s)
- Erfei Luo
- School of Medicine, Southeast University, Nanjing, China
| | - Dong Wang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Bo Liu
- School of Medicine, Southeast University, Nanjing, China
| | - Jiantong Hou
- School of Medicine, Southeast University, Nanjing, China
| | - Gaoliang Yan
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
| | - Chengchun Tang
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing, China
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16
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Jiang YJ, Zhang ZF, Gu ZM, Zou HD, Fan WH, Chen XJ, Wang HY. Timely identification of atypical acute aortic dissection in the emergency department:a study from a tertiary hospital. Turk J Med Sci 2019; 49:1308-1316. [PMID: 31648436 PMCID: PMC7018218 DOI: 10.3906/sag-1808-96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 05/25/2019] [Indexed: 01/16/2023] Open
Abstract
Background/aim Acute aortic dissection (AAD) is a rare but fatal disease if left untreated. Symptoms are often similar to common conditions; therefore, the diagnostic strategy is important. We aimed to identify the atypical symptoms in a timely manner without putting patients at greater risk for undetected AAD. Materials and methods We conducted a retrospective observational study of 59 AAD patients with both atypical and typical symptoms from January 2012 to December 2016. Patients with atypical symptoms continuing more than 30 min underwent a D-dimer test and computed tomography (CT) or computed tomographic angiography (CTA). Results Of the 59 AAD patients, 22 were atypical. In the atypical group, the median delay time in our hospital was 3.1 h; average delay time after July 2015 was shorter than average delay time before June 2015 (16.59 ± 24.70 vs. 1.90 ± 0.57 h, P = 0.076). Conclusions For patients in the emergency department who are suspected of having AAD, incorporating atypical symptoms with high levels of D-dimer into a triage strategy could improve the efficiency of clinical decision making. Furthermore, essential education directed towards the recognition of the atypical symptoms of AAD for front-line physicians may aid in a timely diagnosis, as compared with the usual assessments in the emergency department.
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Affiliation(s)
- You-Jin Jiang
- Department of Emergency, Maanshan People’s Hospital, Maanshan, Anhui, China
| | - Zheng-Fang Zhang
- Department of Emergency, Maanshan People’s Hospital, Maanshan, Anhui, China
| | - Zhi-Ming Gu
- Department of Emergency, Maanshan People’s Hospital, Maanshan, Anhui, China
| | - Heng-Di Zou
- Department of Emergency, Maanshan People’s Hospital, Maanshan, Anhui, China
| | - Wen-Hui Fan
- Department of Emergency, Maanshan People’s Hospital, Maanshan, Anhui, China
| | - Xiao-Jun Chen
- Department of Emergency, Maanshan People’s Hospital, Maanshan, Anhui, China
| | - Hong-You Wang
- Department of Emergency, Maanshan People’s Hospital, Maanshan, Anhui, China
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18
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Itagaki R, Kimura N, Mieno M, Hori D, Itoh S, Akiyoshi K, Yuri K, Tanno K, Kawahito K, Yamaguchi A. Characteristics and Treatment Outcomes of Acute Type A Aortic Dissection With Elevated D-Dimer Concentration. J Am Heart Assoc 2018; 7:JAHA.118.009144. [PMID: 29987123 PMCID: PMC6064831 DOI: 10.1161/jaha.118.009144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Clinical characteristics and treatment outcomes of acute type A aortic dissection with D‐dimer elevation have not been clarified. Methods and Results D‐dimer was measured preoperatively within 24 hours of symptom onset in 262 patients with acute type A aortic dissection. The median (and interquartile range) admission D‐dimer concentration in our total patient group was 26.7 (8.3–85.9) μg/mL. Median (interquartile range) D‐dimer concentrations were 5.0 (2.6–18.0) μg/mL for complete false lumen thrombosis (n=33), 60.9 (19.4–160.4) μg/mL for partial thrombosis (n=81), 26.5 (10.0–70.6) μg/mL for a patent false lumen (n=131), and 8.7 (3.2–26.9) μg/mL for ulcerlike projection (n=17) (P<0.01). With a D‐dimer concentration of ≤8.3 μg/mL representing the lower quartile, we then investigated predictors of a low D‐dimer level. Multivariate analysis showed dissection limited to the ascending aorta (P<0.01; odds ratio, 9.81) or descending aorta (P<0.01; odds ratio, 7.68), a completely thrombosed false lumen (P<0.01; odds ratio, 4.02), and absence of brain ischemia (P=0.013; odds ratio, 4.74) to be predictors of the lower D‐dimer concentration. Compared with patients with a low D‐dimer concentration (≤8.3 μg/mL, n=66), patients with a D‐dimer concentration >8.3 μg/mL (n=196) had a reduced preoperative platelet count and increased operation time and transfusion volume. In‐hospital mortality was elevated in this group (1.5% versus 11.2%; P=0.031), although 7‐year survival did not differ for hospital survivors (lower versus higher, 93.1% versus 79.1%; P=0.21). Conclusions D‐dimer concentrations are strongly influenced by the extent of dissection and false lumen status. Operative risks are increased in patients with a relatively high D‐dimer concentration.
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Affiliation(s)
- Ryo Itagaki
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Naoyuki Kimura
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Makiko Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Satoshi Itoh
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Akiyoshi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Keisuke Tanno
- Department of Radiology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Koji Kawahito
- Division of Cardiovascular Surgery, Department of Surgery, Jichi Medical University, Shimotsuke, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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19
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Ohle R, Kareemi HK, Wells G, Perry JJ. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. Acad Emerg Med 2018; 25:397-412. [PMID: 29265487 DOI: 10.1111/acem.13360] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/22/2017] [Accepted: 12/01/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Acute aortic dissection is a life-threatening condition due to a tear in the aortic wall. It is difficult to diagnose and if missed carries a significant mortality. METHODS We conducted a librarian-assisted systematic review of PubMed, MEDLINE, Embase, and the Cochrane database from 1968 to July 2016. Titles and abstracts were reviewed and data were extracted by two independent reviewers (agreement measured by kappa). Studies were combined if low clinical and statistical heterogeneity (I2 < 30%). Study quality was assessed using the QUADAS-2 tool. Bivariate random effects meta analyses using Revman 5 and SAS 9.3 were performed. RESULTS We identified 792 records: 60 were selected for full text review, nine studies with 2,400 participants were included (QUADAS-2 low risk of bias, κ = 0.89 [for full-text review]). Prevalence of aortic dissection ranged from 21.9% to 76.1% (mean ± SD = 39.1% ± 17.1%). The clinical findings increasing probability of aortic dissection were 1) neurologic deficit (n = 3, specificity = 95%, positive likelihood ratio [LR+] = 4.4, 95% confidence interval [CI] = 3.3-5.7, I2 = 0%) and 2) hypotension (n = 4, specificity = 95%, LR+ = 2.9 95% CI = 1.8-4.6, I2 = 42%), and decreasing probability were the absence of a widened mediastinum (n = 4, sensitivity = 76%-95%, negative likelihood ratio [LR-] = 0.14-0.60, I2 = 93%) and an American Heart Association aortic dissection detection (AHA ADD) risk score < 1 (n = 1, sensitivity = 91%, LR- = 0.22, 95% CI = 0.15-0.33). CONCLUSIONS Suspicion for acute aortic dissection should be raised with hypotension, pulse, or neurologic deficit. Conversely, a low AHA ADD score decreases suspicion. Clinical gestalt informed by high- and low-risk features together with an absence of an alternative diagnosis should drive investigation for acute aortic dissection.
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Affiliation(s)
- Robert Ohle
- Department of Emergency Medicine; Ottawa Hospital Research Institute; University of Ottawa; Ottawa Ontario
| | | | - George Wells
- Department of Epidemiology and Community Medicine; University of Ottawa; Ottawa Ontario
- Cardiovascular Research Methods Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - Jeffrey J. Perry
- Cardiovascular Research Methods Centre; University of Ottawa Heart Institute; Ottawa Ontario Canada
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20
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Type A Aortic Dissection Presenting with Neurological Symptoms Mimicking Stroke and Intracranial Hemorrhage. REPORTS 2018. [DOI: 10.3390/reports1010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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21
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Akutsu K, Yamanaka H, Katayama M, Yamamoto T, Takayama M, Osaka M, Sato N, Shimizu W. Usefulness of Measuring the Serum Elastin Fragment Level in the Diagnosis of an Acute Aortic Dissection. Am J Cardiol 2016; 118:1405-1409. [PMID: 27666178 DOI: 10.1016/j.amjcard.2016.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
Previous reports have shown that serum elastin fragments (SEFs) may be a useful biomarker for the diagnosis of an acute aortic dissection (AAD). However, because the reference interval of SEFs has not been established, it has not been determined whether SEFs are really useful for the diagnosis of AAD. The purpose of this study was to determine the usefulness of measuring SEFs for the diagnosis of AAD. A total of 42 consecutive patients aged 68 ± 18 years who were diagnosed with an AAD were studied. Patient background and SEF levels were examined on admission. SEF levels were also measured in patients undergoing a medical examination (n = 531, age 54 ± 17 years) to compare with those with an AAD. In the control group, SEF levels increased with age (R = 0.725, p <0.001). Then, we defined the upper limit of the reference interval of SEF levels as the 97.5th percentile of control SEF grouped by decade of life from the sixth to ninth decade. The overall risk of AAD exceeding the upper limit of the reference interval at each decade was 10% (4 of 42). For patients in their 60s and 70s, median SEF levels in the AAD group (89 [77 to 104], 93 [60 to 123] ng/ml, respectively) were not significantly higher than those in the control group (79 [68 to 92], 90 [79 to 106] ng/ml, respectively; p = 0.081 and 0.990, respectively). Our data suggest that measuring SEF levels may not be useful in the diagnosis of an AAD as the upper limit of the reference interval of the SEF level was unexpectedly higher.
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Affiliation(s)
- Koichi Akutsu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan.
| | - Hiroyuki Yamanaka
- Cardiology and Intensive Care Units, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan; Department of Internal Medicine and Cardiology, Tsurumi University School of Dental Medicine, Kanagawa, Japan
| | - Masahiko Katayama
- Pharmaceutical Laboratories, Mochida Pharmaceutical Co., Ltd., Shizuoka, Japan
| | - Takeshi Yamamoto
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan
| | - Morimasa Takayama
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan; Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Motohisa Osaka
- Cardiology and Intensive Care Units, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Naoki Sato
- Cardiology and Intensive Care Units, Nippon Medical School Musashi Kosugi Hospital, Kanagawa, Japan
| | - Wataru Shimizu
- Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Giannitsis E, Mair J, Christersson C, Siegbahn A, Huber K, Jaffe AS, Peacock WF, Plebani M, Thygesen K, Möckel M, Mueller C, Lindahl B. How to use D-dimer in acute cardiovascular care. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:69-80. [PMID: 26450781 DOI: 10.1177/2048872615610870] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
D-dimer testing is important to aid in the exclusion of venous thromboembolic events (VTEs), including deep venous thrombosis and pulmonary embolism, and it may be used to evaluate suspected aortic dissection. D-dimer is produced upon activation of the coagulation system with the generation and subsequent degradation of cross-linked fibrin by plasmin. Many different assays for D-dimer testing are currently used in routine care. However, these tests are neither standardized nor harmonized. Consequently, only clinically validated assays and assay specific decision limits should be used for routine testing. For the exclusion of pulmonary embolism/deep vein thrombosis, age-adjusted cut-offs are recommend. Clinicians must be aware of the validated use of their hospital's D-dimer assay to avoid inappropriate use of this biomarker in routine care.
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Affiliation(s)
| | - Johannes Mair
- 2 Department of Internal Medicine III, Medical University Innsbruck, Austria
| | | | | | - Kurt Huber
- 5 Department of Medicine, Wilhelminen Hospital, Austria
| | | | | | - Mario Plebani
- 8 Department of Laboratory Medicine, University Hospital, Italy
| | | | - Martin Möckel
- 10 Division of Emergency Medicine, Charité-Universitätsmedizin Berlin, Germany
| | | | - Bertil Lindahl
- 12 Department of Medical Sciences, Uppsala University, Sweden
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Diagnostic test accuracy of D-dimer for acute aortic syndrome: systematic review and meta-analysis of 22 studies with 5000 subjects. Sci Rep 2016; 6:26893. [PMID: 27230962 PMCID: PMC4882530 DOI: 10.1038/srep26893] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 05/10/2016] [Indexed: 11/08/2022] Open
Abstract
Diagnostic test accuracy of D-dimer for acute aortic dissection (AAD) has not been evaluated by meta-analysis with the bivariate model methodology. Four databases were electrically searched. We included both case-control and cohort studies that could provide sufficient data concerning both sensitivity and specificity of D-dimer for AAD. Non-English language articles and conference abstract were allowed. Intramural hematoma and penetrating aortic ulcer were regarded as AAD. Based on 22 eligible articles consisting of 1140 AAD subjects and 3860 non-AAD subjects, the diagnostic odds ratio was 28.5 (95% CI 17.6-46.3, I(2) = 17.4%) and the area under curve was 0.946 (95% CI 0.903-0.994). Based on 833 AAD subjects and 1994 non-AAD subjects constituting 12 studies that used the cutoff value of 500 ng/ml, the sensitivity was 0.952 (95% CI 0.901-0.978), the specificity was 0.604 (95% CI 0.485-0.712), positive likelihood ratio was 2.4 (95% CI 1.8-3.3), and negative likelihood ratio was 0.079 (95% CI 0.036-0.172). Sensitivity analysis using data of three high-quality studies almost replicated these results. In conclusion, D-dimer has very good overall accuracy. D-dimer <500 ng/ml largely decreases the possibility of AAD. D-dimer >500 ng/ml moderately increases the possibility of AAD.
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Hussain S, Barbarite E, Chaudhry NS, Gupta K, Dellarole A, Peterson EC, Elhammady MS. Search for Biomarkers of Intracranial Aneurysms: A Systematic Review. World Neurosurg 2015; 84:1473-83. [DOI: 10.1016/j.wneu.2015.06.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/15/2015] [Accepted: 06/16/2015] [Indexed: 11/16/2022]
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25
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A Systematic Review and Meta-analysis of D-dimer as a Rule-out Test for Suspected Acute Aortic Dissection. Ann Emerg Med 2015; 66:368-78. [DOI: 10.1016/j.annemergmed.2015.02.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/07/2015] [Accepted: 02/17/2015] [Indexed: 11/17/2022]
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26
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Kurakula N, Durgaprasad R, Velam V, Akula VS, Kasala L, Muvva KV. Predictive Value of D-Dimer Levels and Tissue Doppler Mitral Annular Systolic Velocity for Detection of Left Atrial Appendage Thrombus in Patients with Mitral Stenosis in Sinus Rhythm. Echocardiography 2015; 33:264-75. [PMID: 26239565 DOI: 10.1111/echo.13026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transesophageal echocardiogram (TEE) is a gold standard test for diagnosis of left atrial (LA) thrombus, but it has limited sensitivity for identification of small thrombi within side lobes. Thus, the absence of visualizing a left atrial appendage (LAA) thrombus does not equate with the absence of a LAA thrombus. AIM To assess the predictive value of mitral annular systolic velocity (Sa) and D-dimer for the detection of LA thrombus and spontaneous echocardiographic contrast (SEC) in mitral stenosis (MS) patients with sinus rhythm (SR). METHODS Transthoracic echocardiogram, TEE, and D-dimer analysis were performed in 104 severe MS patients and divided them into three groups: Group I:no LA thrombus or SEC; Group II:LA SEC only; and Group III:LA thrombus. RESULTS Group III had more severe New York Heart Association (NYHA) class (III-IV) dyspnea and lower Sa (6.9 ± 0.7 vs.10.0 ± 1.2 cm/sec), lower LAA late emptying velocity (17.7 ± 2.1 vs. 24.4 ± 4.2 cm/sec), larger LA transverse dimension, and LAA area (LAAA) than group I+II. Mean D-dimer levels were higher in groups III and II than in group I. In multivariate analysis Sa, D-dimer levels, LAAA, and NYHA class were independent predictors of LA thrombus. ROC curve analysis revealed that higher Sa >8 cm/sec and lower D-dimer levels <370 μg/L predict the absence of LA thrombus and lower Sa <8 cm/sec and higher D-dimer levels >510 μg/L predict the presence of LA thrombus. CONCLUSION Measurement of Sa and D-dimer levels is necessary for better assessment of LA thrombus and SEC, for identification of patients who are at high risk for LA thrombus formation and for initiation of prophylactic anticoagulation.
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Affiliation(s)
- Naresh Kurakula
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Rajasekhar Durgaprasad
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Vanajakshamma Velam
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Vidya Sagar Akula
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
| | - Latheef Kasala
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, India
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Penn JL, Martindale JL, Milne LW, Marill KA. Aortic dissection associated with blunt chest trauma diagnosed by elevated D-dimer. Int J Surg Case Rep 2015; 10:76-9. [PMID: 25805614 PMCID: PMC4429846 DOI: 10.1016/j.ijscr.2015.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 03/13/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Similar to spontaneous aortic dissection, traumatic aortic dissection is diagnosed with a careful history and physical exam, chest radiograph, and ultimately, dedicated aortic imaging. The diagnosis of spontaneous aortic dissection may be aided by using the serum D-dimer test. The use of D-dimer for diagnosing aortic injury in the setting of blunt trauma has not previously been reported. PRESENTATION OF CASE We present a case of aortic dissection in a 61-year-old male diagnosed when the patient presented with chest pain after blunt chest trauma. DISCUSSION The patient had no known history or risk factors for aortic disease. None of the classic findings were present by history, physical examination or chest radiograph and the diagnosis was made as the result of an elevated D-dimer. We discuss how the D-dimer test fortuitously led to the diagnosis in this case, and the implications. CONCLUSION D-dimer could be helpful in diagnosing aortic injuries in low-risk chest trauma patients.
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Affiliation(s)
- Joshua L Penn
- Harvard Affiliated Emergency Medicine Residency, Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Neville House - 236A, Boston, Massachusetts 02115, USA
| | - Jennfier L Martindale
- Harvard Affiliated Emergency Medicine Residency, Department of Emergency Medicine, Harvard Medical School, 75 Francis Street, Neville House - 236A, Boston, Massachusetts 02115, USA
| | - Leslie W Milne
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 3B, Boston, Massachusetts 02114, USA
| | - Keith A Marill
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Zero Emerson Place, Suite 3B, Boston, Massachusetts 02114, USA.
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Li Y, Li L, Mu HS, Fan SL, He FG, Wang ZY. Aortic Dissection and Sudden Unexpected Deaths: A Retrospective Study of 31 Forensic Autopsy Cases. J Forensic Sci 2015; 60:1206-11. [PMID: 25771939 DOI: 10.1111/1556-4029.12768] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 11/26/2022]
Abstract
Acute aortic dissection (AAD) is the most common cause of sudden unexpected death related to aortic diseases. A retrospective study of 31 sudden unexpected deaths caused by AAD was conducted at Xi'an Jiaotong University Forensic Center from 2001 to 2012. We summarized the forensic characteristics of AAD and assessed the clinically diagnostic accuracy of AAD. The characteristics of sudden unexpected death due to AAD were male predominant (male: female=6.7:1), relatively young with the mean age of 44, and predominance of type A dissection (77.4%). Cardiac tamponade was the most frequent cause of sudden death (87.1%). Of the 31 cases, 26 (83.9%) patients were not recognized clinically and were misdiagnosed with acute myocardial infarction, coronary artery disease, cholecystitis, acute gastroenteritis, renal/urinary lithiasis, or acute pancreatitis. In summary, AAD can be difficult to recognize, diagnosis is therefore sometimes delayed or missed. The medicolegal death investigation can help physicians have a better understanding of AAD.
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Affiliation(s)
- Yang Li
- School of Forensic Medicine, Xi'an Jiaotong University, Shaanxi, 710061, China
| | - Ling Li
- Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223
| | - Hong-Shu Mu
- Xian'yang Wei-cheng Public Security Bureau, Shaanxi, 712000, China
| | - Shuan-Liang Fan
- School of Forensic Medicine, Xi'an Jiaotong University, Shaanxi, 710061, China
| | - Fang-Gang He
- Office of the Chief Medical Examiner, 900 West Baltimore Street, Baltimore, MD, 21223
| | - Zhen-Yuan Wang
- School of Forensic Medicine, Xi'an Jiaotong University, Shaanxi, 710061, China
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Takahashi C, Sasaki T. Consideration of two cases of ascending aortic dissection that began with stroke-like symptoms. Case Rep Neurol Med 2015; 2015:829756. [PMID: 25664193 PMCID: PMC4312608 DOI: 10.1155/2015/829756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/07/2014] [Accepted: 12/26/2014] [Indexed: 11/18/2022] Open
Abstract
We recently experienced two patients with stroke-like symptoms and ascending aortic dissection (AAD) in our outpatient department. Both patients were transferred to our hospital presenting with neurological deficit such as hemiparesis and conjugate deviation. They did not complain from any chest or abdominal pain. Their MRI did not show fresh infarction or main branch occlusion. A chest CT image showed AAD. The former patient was immediately transferred to a tertiary hospital and the latter received conservative management in the cardiovascular department. Discussion. As neither patient was experiencing any pain, we initially diagnosed them with ischemic stroke and began treatment. Fortunately, bleeding complications did not occur. In such cases, problems are caused when intravenous tissue plasminogen activator (t-PA) injection is administered with the aim of reopening the occluded intracranial arteries. In fact, patients with AAD undergoing t-PA injection have been reported to die from bleeding complications without any recognition of the dissection. These findings suggest that confirmation using carotid ultrasound, carotid MR angiography, and a D-dimer test is crucial and should be adopted in emergency departments.
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Affiliation(s)
- Chiaki Takahashi
- Department of Neurosurgery, Itoigawa General Hospital, 457-1 Takegahana, Itoigawa, Niigata 941-0006, Japan
| | - Takashi Sasaki
- Department of Neurosurgery, Takaoka City Hospital, 4-1 Takara-machi, Takaoka, Toyama 933-8550, Japan
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30
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Diercks DB, Promes SB, Schuur JD, Shah K, Valente JH, Cantrill SV, Cantrill SV, Brown MD, Burton JH, Diercks DB, Gemme SR, Gerardo CJ, Godwin SA, Hahn SA, Haukoos JS, Huff JS, Lo BM, Mace SE, Moon MD, Nazarian DJ, Promes SB, Shah K, Shih RD, Silvers SM, Smith MD, Tomaszewski CA, Valente JH, Wolf SJ, O'Connor RE, Whitson RR. Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients With Suspected Acute Nontraumatic Thoracic Aortic Dissection. Ann Emerg Med 2015; 65:32-42.e12. [DOI: 10.1016/j.annemergmed.2014.11.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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31
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Cui JS, Jing ZP, Zhuang SJ, Qi SH, Li L, Zhou JW, Zhang W, Zhao Y, Qi N, Yin YJ. D-dimer as a biomarker for acute aortic dissection: a systematic review and meta-analysis. Medicine (Baltimore) 2015; 94:e471. [PMID: 25634194 PMCID: PMC4602956 DOI: 10.1097/md.0000000000000471] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To perform a meta-analysis and examine the use of D-dimer levels for diagnosing acute aortic dissection (AAD). Medline, Cochrane, EMBASE, and Google Scholar were searched until April 23, 2014, using the following search terms: biomarker, acute aortic dissection, diagnosis, and D-dimer. Inclusion criteria were diagnosis of acute aortic dissection, D-dimer levels obtained, 2-armed study. Outcome measures were the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of D-dimer level for the diagnosis of AAD. Sensitivity analysis was performed using the leave-one-out approach. Of 34 articles identified, 5 met the inclusion criteria and were included in the analysis. The age of participants was similar between treatments within studies. The number of AAD patients ranged from 16 to 107 (total = 274), and the number of control group patients ranged from 32 to 206 (total = 469). The pooled sensitivity of D-dimer levels in AAD patients was 94.5% (95% confidence interval [CI] 78.1%-98.8%, P < 0.001), and the specificity was 69.1% (95% CI 43.7%-86.5%, P = 0.136). The pooled area under the receiver-operating characteristic curve for D-dimer levels in AAD patients was 0.916 (95% CI 0.863-0.970, P < 0.001). The direction and magnitude of the combined estimates did not change markedly with the exclusion of individual studies, indicating the meta-analysis had good reliability. D-dimer levels are best used for ruling out AAD in patients with low likelihood of the disease.
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Affiliation(s)
- Jia-Sen Cui
- From the Department of Vascular Surgery, Huadong Hospital, The Fudan University (J-sC, S-jZ, S-hQ, LL, J-wZ, WZ, YZ, NQ, Y-jY); Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Institute of Vascular Surgery of PLA, Shanghai, China (Z-pJ)
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Goldberg SA, Kharbanda B, Pepe PE. Year in review 2013: Critical Care--out-of-hospital cardiac arrest, traumatic injury, and other emergency care conditions. Crit Care 2014; 18:593. [PMID: 25672494 PMCID: PMC4330928 DOI: 10.1186/s13054-014-0593-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In this review, we discuss articles published in 2013 contributing to the existing literature on the management of out-of-hospital cardiac arrest and the evaluation and management of several other emergency conditions, including traumatic injury. The utility of intravenous medications, including epinephrine and amiodarone, in the management of cardiac arrest is questioned, as are cardiac arrest termination-of-resuscitation rules. Articles discussing mode of transportation in trauma are evaluated, and novel strategies for outcome prediction in traumatic injury are proposed. Diagnostic strategies, including computerized tomography scan for the diagnosis of smoke inhalation injury and serum biomarkers for the diagnosis of post-cardiac arrest syndrome and acute aortic dissection, are also explored. Although many of the articles discussed raise more questions than they answer, they nevertheless provide ample opportunity for further investigation.
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Affiliation(s)
- Scott A Goldberg
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115 USA
| | - Bryan Kharbanda
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115 USA
| | - Paul E Pepe
- Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Neville House, Boston, MA 02115 USA
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Albini P, Barshes NR, Russell L, Wu D, Coselli JS, Shen YH, Allison PM, LeMaire SA. D-dimer levels remain elevated in acute aortic dissection after 24 h. J Surg Res 2014; 191:58-63. [DOI: 10.1016/j.jss.2014.03.074] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 03/20/2014] [Accepted: 03/25/2014] [Indexed: 11/17/2022]
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Diagnosis and Management of Acute Aortic Syndromes: Dissection, Intramural Hematoma, and Penetrating Aortic Ulcer. Curr Cardiol Rep 2014; 16:536. [DOI: 10.1007/s11886-014-0536-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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36
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Shao N, Xia S, Wang J, Zhou X, Huang Z, Zhu W, Chen Y. The role of D-dimers in the diagnosis of acute aortic dissection. Mol Biol Rep 2014; 41:6397-403. [PMID: 25038723 DOI: 10.1007/s11033-014-3520-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 06/19/2014] [Indexed: 11/28/2022]
Abstract
Acute aortic dissection (AAD) is a life threatening cardiovascular medical emergency with a poor prognosis. To explore the utility of D-dimers (DD) in the diagnosis of AAD, we performed a prospective study and conducted a meta-analysis of previous studies. 368 suspected patients were enrolled, including AAD n = 89, PE n = 12, AMI n = 167, normal controls n = 100. All patients had a DD test immediately after admission. We then performed a comprehensive computer search to identify studies investigating using DD as a screening tool for AAD. Finally, we pooled these data to estimate sensitivity, specificity, positive and negative likelihood ratios (LRs) by using DerSimonian-Laird random-effects models. The DD concentrations in the AAD group were significantly higher than those in the AMI and normal control groups. However, the DD level of 500 ng/ml had a poor sensitivity of 51.7 % and specificity of 89.2 % in the diagnosis of AAD. Subgroup analyses found that DD only showed a well discriminative ability of distinguishing AAD patients from normal controls (specificity and positive LR was 97 % and 17.2, respectively). The pooled sensitivity, specificity, positive and negative LR in our meta-analysis was 89, 68 %, 2.71, 0.07, respectively. In conclusion, our results suggest that plasma DD levels cannot add to the certainty of AAD diagnosis and it is not a good biomarker for AAD. In the future, prospective research on patients from many parts of the world is warranted to validate our findings. In addition, different controls, methods of plasma DD assays and other factors should be considered.
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Affiliation(s)
- Ning Shao
- Department of Urology, Second People's Hospital of Wuxi Affiliated to Nanjing Medical University, 68 Zhongshan Road, Wuxi, 214002, People's Republic of China
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Coyle S, Moriarty T, Melody L, Ryan D. Diagnostic Testing in Acute Aortic Dissection. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2014. [DOI: 10.1007/s40138-014-0044-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Ibupoto ZH, Mitrou N, Nikoleli GP, Nikolelis DP, Willander M, Psaroudakis N. The Development of Highly Sensitive and Selective Immunosensor Based on Antibody Immobilized ZnO Nanorods for the Detection of D-Dimer. ELECTROANAL 2014. [DOI: 10.1002/elan.201300580] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Leitman IM, Suzuki K, Wengrofsky AJ, Menashe E, Poplawski M, Woo KM, Geller CM, Lucido D, Bernik T, Zeifer BA, Patton B. Early recognition of acute thoracic aortic dissection and aneurysm. World J Emerg Surg 2013; 8:47. [PMID: 24499618 PMCID: PMC3874654 DOI: 10.1186/1749-7922-8-47] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 10/31/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thoracic aortic dissection (TAD) and aneurysm (TAA) are rare but catastrophic. Prompt recognition of TAD/TAA and differentiation from acute coronary syndrome (ACS) is difficult yet crucial. Earlier identification of TAA/TAD based upon routine emergency department screening is necessary. METHODS A retrospective analysis of patients that presented with acute thoracic complaints to the ED from January 2007 through June 2012 was performed. Cases of TAA/TAD were compared to an equal number of controls which consisted of patients with the diagnosis of ACS. Demographics, physical findings, EKG, and the results of laboratory and radiological imaging were compared. P-value of > 0.05 was considered statistically significant. RESULTS In total, 136 patients were identified with TAA/TAD, 0.36% of patients that presented with chest complaints. Compared to ACS patients, TAA/TAD group was older (68.9 vs. 63.2 years), less likely to be diabetic (13% vs 32%), less likely to complain of chest pain (47% vs 85%) and head and neck pain (4% vs 17%). The pain for the TAA/TAD group was less likely characterized as tight/heavy in nature (5% vs 37%). TAA/TAD patients were also less likely to experience shortness of breath (42% vs. 51%), palpitations (2% vs 9%) and dizziness (2% vs 13%) and had a greater incidence of focal lower extremity neurological deficits (6% vs 1%), bradycardia (15% vs. 5%) and tachypnea (53% vs. 22%). On multivariate analysis, increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction were independent predictors of ACS. CONCLUSIONS Increasing heart rate, chest pain, diabetes, head & neck pain, dizziness, and history of myocardial infarction can be used to differentiate acute coronary syndromes from thoracic aortic dissections/aneurysms.
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Affiliation(s)
- I Michael Leitman
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - Kei Suzuki
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - Aaron J Wengrofsky
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - Eyal Menashe
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - Michal Poplawski
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - Kar-Mun Woo
- Emergency Medicine, Albert Einstein College of Medicine-Beth Israel Medical Center, New York, NY, USA
| | - Charles M Geller
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - David Lucido
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - Thomas Bernik
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
| | - Barbara A Zeifer
- Radiology, Albert Einstein College of Medicine-Beth Israel Medical Center, New York, NY, USA
| | - Byron Patton
- Departments of Surgery, Albert Einstein College of Medicine-Beth Israel Medical Center, 10 Union Square East, Suite 2M, New York, NY 10003, USA
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Lovy AJ, Bellin E, Levsky JM, Esses D, Haramati LB. Preliminary development of a clinical decision rule for acute aortic syndromes. Am J Emerg Med 2013; 31:1546-50. [PMID: 24055476 DOI: 10.1016/j.ajem.2013.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 06/07/2013] [Accepted: 06/22/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Patients with suspected acute aortic syndromes (AAS) often undergo computed tomography (CT) with negative results. We sought clinical and diagnostic criteria to identify low-risk patients, an initial step in developing a clinical decision rule. METHODS We retrospectively identified all adults presenting to our emergency department (ED) from January 1, 2006, to August 1, 2010, who underwent CT angiography for suspected AAS without prior trauma or AAS. A total of 1465 patients met inclusion criteria; a retrospective case-controlled review (ratio 1:4) was conducted. Cases were diagnosed with aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or ruptured aneurysm. RESULTS Of the patients who underwent CT, 2.7% (40/1465) had an AAS; 2 additional cases were diagnosed after admission (ED miss rate, 5% [2/42]). Patients with AAS were significantly older than controls (66 vs 59 years; P = .008). Risk factors included abnormal chest radiograph (sensitivity, 79% [26/33]; specificity, 82% [113/137]) and acute chest pain (sensitivity, 83% [29/35]; specificity, 71% [111/157]). None of the 19 patients with resolved pain upon ED presentation had AAS. These data support a 2-step rule: first screen for ongoing pain; if present, screen for acute chest pain or an abnormal chest radiograph. This approach achieves a 54% (84/155) reduction in CT usage with a sensitivity for AAS of 96% (95% confidence interval, 89%-100%), negative predictive value of 99.8% (99.4%-100%), and a false-negative rate of 1.7% (1/84). CONCLUSIONS Our results demonstrate a need to safely identify patients at low risk for AAS who can forgo CT. We developed a preliminary 2-step clinical decision rule, which requires validation.
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Affiliation(s)
- Andrew J Lovy
- Mount Sinai Medical Center, Department of Orthopedics, New York, NY
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Taylor RA, Iyer NS. A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection. Am J Emerg Med 2013; 31:1047-55. [DOI: 10.1016/j.ajem.2013.03.039] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 03/19/2013] [Accepted: 03/23/2013] [Indexed: 12/12/2022] Open
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Wen D, Du X, Dong JZ, Zhou XL, Ma CS. Value of D-dimer and C reactive protein in predicting inhospital death in acute aortic dissection. Heart 2013; 99:1192-7. [DOI: 10.1136/heartjnl-2013-304158] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Giachino F, Loiacono M, Lucchiari M, Manzo M, Battista S, Saglio E, Lupia E, Moiraghi C, Hirsch E, Mengozzi G, Morello F. Rule out of acute aortic dissection with plasma matrix metalloproteinase 8 in the emergency department. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R33. [PMID: 23442769 PMCID: PMC4057269 DOI: 10.1186/cc12536] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/20/2013] [Indexed: 12/21/2022]
Abstract
Introduction Matrix metalloproteinases (MMPs) are involved in aortic pathophysiology. Preliminary studies have detected increased plasma levels of MMP8 and MMP9 in patients with acute aortic dissection (AAD). However, the performance of plasma MMP8 and MMP9 for the diagnosis of AAD in the emergency department is at present unknown. Methods The levels of MMP8 and MMP9 were measured by ELISA on plasma samples obtained from 126 consecutive patients evaluated in the emergency department for suspected AAD. All patients were subjected to urgent computed tomography (CT) scan for final diagnosis. Results In the study cohort (N = 126), AAD was diagnosed in 52 patients and ruled out in 74 patients. Median plasma MMP8 levels were 36.4 (interquartile range 24.8 to 69.3) ng/ml in patients with AAD and 13.2 (8.1 to 31.8) ng/ml in patients receiving an alternative final diagnosis (P <0.0001). Median plasma MMP9 levels were 169.2 (93.0 to 261.8) ng/ml in patients with AAD and 80.5 (41.8 to 140.6) ng/ml in patients receiving an alternative final diagnosis (P = 0.001). The area under the curve (AUC) on receiver-operating characteristic (ROC) analysis of MMP8 and MMP9 for the diagnosis of AAD was respectively 0.75 and 0.70, as compared to 0.87 of D-dimer. At the cutoff of 3.6 ng/ml, plasma MMP8 had a sensitivity of 100.0% (95% CI, 93.2% to 100.0%) and a specificity of 9.5% (95% CI, 3.9% to 18.5%) and ruled out AAD in 5.6% of patients. Combination of plasma MMP8 with D-dimer increased the AUC on ROC analysis to 0.89. Presence of MMP8 <11.0 ng/ml and D-dimer <1.0 or <2.0 µg/ml provided a negative predictive value of 100% and ruled out AAD in 13.6% and 21.4% of patients respectively. Conclusions Low levels of plasma MMP8 can rule out AAD in a minority of patients. Combination of plasma MMP8 and D-dimer at individually suboptimal cutoffs could safely rule out AAD in a substantial proportion of patients evaluated in the emergency department.
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Yuan SM, Shi YH, Wang JJ, Lü FQ, Gao S. Elevated plasma D-dimer and hypersensitive C-reactive protein levels may indicate aortic disorders. Braz J Cardiovasc Surg 2012; 26:573-81. [PMID: 22358272 DOI: 10.5935/1678-9741.20110047] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Accepted: 10/09/2011] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE D-dimer and C-reactive protein are of diagnostic and predictive values in patients have thrombotic tendency, such as vascular thrombosis, coronary artery disease and aortic dissection. However, the comparative study in these biomarkers between the patients with acute aortic dissection and coronary artery disease has not been sufficiently elucidated. METHODS Consecutive surgical patients for acute type A aortic dissection (20 patients), aortic aneurysm (nine patients) or coronary artery disease (20 patients) were selected into this study. Plasma from preoperative blood samples and supernatant of aortic homogenate of the surgical specimens were detected for D-dimer and hypersensitive C-reactive protein (hs-CRP). RESULTS Plasma D-dimer and hs-CRP values in type A aortic dissection or aortic aneurysm were much higher than in coronary artery disease patients or the healthy control (for D-dimer, aortic dissection: coronary artery disease, 0.4344 ± 0.2958 µg/ml vs. 0.0512 ± 0.0845 µg/ml, P < 0.0001; aortic dissection: healthy control, 0.4344 ± 0.2958 µg/ml vs. 0.1250 ± 0.1295 µg/ml, P = 0.0005; aortic aneurysm: coronary artery disease, 0.4200 ± 0.4039 µg/ml vs. 0.0512 ± 0.0845 µg/ml, P = 0.0013; and aortic aneurysm: healthy control, 0.4200 ± 0.4039 µg/ml vs. 0.1250 ± 0.1295 µg/ml, P = 0.0068; and for hs-CRP, aortic dissection: coronary artery disease, 4.400± 3.004 mg/L vs. 1.232±0.601 mg/L, P < 0.0001; aortic dissection:healthy control, 4.400 ± 3.004 mg/L vs. 0.790 ± 0.423 mg/L, P < 0.0001; aortic aneurysm: coronary artery disease, 2.314 ± 1.399 mg/L vs. 1.232 ± 0.601 mg/L, P = 0.0084; aortic aneurysm: healthy control, 2.314 ± 1.399 mg/L vs. 0.790 ± 0.423 mg/L, P = 0.0002; and coronary artery disease: healthy control, 1.232 ± 0.601 mg/L vs. 0.790 ± 0.423 mg/L, P = 0.0113). Besides, there were close correlations between plasma D-dimer and hs-CRP in overall (Y = 4.8798X + 0.8138, r² = 0.4497, r = 0.671, P < 0.001), aortic dissection (Y = 2.6298X + 1.2098, r² = 0.5762, r = 0.759, P < 0.001), and aortic aneurysm (Y = 7.1341X + 1.3006, r² = 0.4935, r = 0.7025, P = 0.048) groups rather than in the coronary artery disease or healthy control subjects. In addition, there were no significant differences between D-dimer and hs-CRP values of the aortic supernatant among groups except for undetectable D-dimer in the aortic supernatant of the coronary artery disease group. CONCLUSIONS The patients with acute aortic dissection and aortic aneurysm may reflect the extensive inflammatory reaction and severe coagulopathies in the patients with acute type A aortic dissection, and thoracic aortic aneurysm in comparison to the coronary patients and healthy control individuals. The detections after onset in the patients with acute chest pain may help making a differential diagnosis between the aortopathies and ischemic heart disease. The scanty significance of the tissue biomarkers may preclude their diagnostic value in clinical practice.
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Affiliation(s)
- Shi-Min Yuan
- Department of Cardiothoracic Surgery, Afiliated Hospital, Taishan Medical College, Taian, Shandong Province, People's Republic of China.
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Upadhye S, Schiff K. Acute Aortic Dissection in the Emergency Department: Diagnostic Challenges and Evidence-Based Management. Emerg Med Clin North Am 2012; 30:307-27, viii. [DOI: 10.1016/j.emc.2011.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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ANTOVIC JP, HÖÖG HAMMARSTRÖM K, FORSLUND G, EINTREI J, STEN-LINDER M. Comparison of five point-of-care D-dimer assays with the standard laboratory method. Int J Lab Hematol 2012; 34:495-501. [DOI: 10.1111/j.1751-553x.2012.01421.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zhan S, Hong S, Shan-shan L, Chen-ling Y, Lai W, Dong-wei S, Chao-yang T, Xian-hong S, Chun-Sheng W. Misdiagnosis of Aortic Dissection: Experience of 361 Patients. J Clin Hypertens (Greenwich) 2012; 14:256-60. [DOI: 10.1111/j.1751-7176.2012.00590.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sievers HH, Schmidtke C. Diagnostische Wege und Irrwege der akuten thorakalen Aortendissektion. Herz 2011; 36:474-9. [DOI: 10.1007/s00059-011-3499-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Shimony A, Filion KB, Mottillo S, Dourian T, Eisenberg MJ. Meta-analysis of usefulness of d-dimer to diagnose acute aortic dissection. Am J Cardiol 2011; 107:1227-34. [PMID: 21296332 DOI: 10.1016/j.amjcard.2010.12.027] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 12/03/2010] [Accepted: 12/03/2010] [Indexed: 01/09/2023]
Abstract
Numerous studies have examined whether plasma D-dimer (DD) can be used to identify patients with acute aortic dissection (AAD). These studies have been inconclusive because of their limited sample sizes and the different cut-off values employed. We aimed to conduct a systematic review and meta-analysis to examine the utility of plasma DD as a screening tool for AAD. We systematically searched EMBASE and MEDLINE and hand-searched relevant articles to identify studies investigating plasma DD as a screening tool for AAD. A value of 500 ng/ml was defined as the threshold for a positive plasma DD finding because it is widely used for ruling out pulmonary emboli. Using DerSimonian-Laird random-effects models we pooled data across studies to estimate sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios (LRs). We identified 7 studies involving 298 subjects with AAD and 436 without. When data were pooled across studies, sensitivity (0.97, 95% confidence interval [CI] 0.94 to 0.99) and negative predictive value (0.96, 95% CI 0.93 to 0.98) were high. Specificity (0.56, 95% CI 0.51 to 0.60) and positive predictive value (0.60, 95% CI 0.55 to 0.66) were low. Negative LR showed an excellent discriminative ability (0.06, 95% CI 0.03 to 0.12), whereas positive LR did not (2.43, 95% CI 1.89 to 3.12). In conclusion, our meta-analysis suggests that plasma DD <500 ng/ml is a useful screening tool to identify patients who do not have AAD. Plasma DD may thus be used to identify subjects who are unlikely to benefit from further aortic imaging.
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