Riccardo Gorla1,2, Raimund Erbel1, Philipp Kahlert1, Konstantinos Tsagakis3, Heinz Jakob3, Amir-Abbas Mahabadi1, Thomas Schlosser4, Holger Eggebrecht5, Eduardo Bossone6, Rolf Alexander Jánosi1. 1. 1 Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany. 2. 2 University of Insubria, Varese, Italy. 3. 3 Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany. 4. 4 Department of Radiology, University Hospital Essen and University Duisburg-Essen, Germany. 5. 5 Cardioangiological Center Bethanien, Germany. 6. 6 Heart Department, University Hospital, Salerno, Italy.
Abstract
BACKGROUND: The role of D-dimer (D-d) as a diagnostic biomarker and its prognostic value in patients with intramural hematoma (IMH) or penetrating aortic ulcer (PAU) are unknown. METHODS: Clinical data of 231 patients with an acute aortic syndrome (AAS) (159 acute aortic dissection [AAD], 35 IMH and 37 PAU) were collected between 2010 and 2014. D-d was determined at admission and during the hospitalization. D-d measurements in 291 patients admitted to the chest pain unit, in whom AAS was ruled out, were used as control. RESULTS: Admission D-d was significantly higher in AAD (12.5±11.1 mg/L) and IMH (14.8±12.2 mg/L) compared with PAU (1.8±1.8 mg/L; p=0.007 and p=0.009, respectively). At a cutoff of 0.5 mg/L, D-d showed superior predictive value for AAD and IMH (sensitivity 99% and 100%, respectively; specificity 67% for both), than for PAU (sensitivity 64%, specificity 67%). Both admission and in-hospital D-d were predictive for in-hospital mortality using a cutoff of 9.0 mg/L (area under the curve 0.68 and 0.78; p=0.019 and p=0.009, respectively). On multivariate analysis, in-hospital D-d ⩾9 mg/L (odds ratio [OR] 5.60, p=0.022), mesenteric ischemia/infarction (OR 5.64, p=0.038) and hypotension/shock/tamponade (OR 11.76, p<0.001) were independent predictors of in-hospital mortality. In contrast, at 3-year follow-up D-d levels did not affect survival. CONCLUSIONS: At a cutoff of 0.5 mg/L, D-d was a reliable diagnostic marker for AAD and IMH, but not for PAU. A mean D-d ⩾9 mg/L during the hospitalization was an independent predictor of in-hospital mortality, but did not affect survival at follow-up.
BACKGROUND: The role of D-dimer (D-d) as a diagnostic biomarker and its prognostic value in patients with intramural hematoma (IMH) or penetrating aortic ulcer (PAU) are unknown. METHODS: Clinical data of 231 patients with an acute aortic syndrome (AAS) (159 acute aortic dissection [AAD], 35 IMH and 37 PAU) were collected between 2010 and 2014. D-d was determined at admission and during the hospitalization. D-d measurements in 291 patients admitted to the chest pain unit, in whom AAS was ruled out, were used as control. RESULTS: Admission D-d was significantly higher in AAD (12.5±11.1 mg/L) and IMH (14.8±12.2 mg/L) compared with PAU (1.8±1.8 mg/L; p=0.007 and p=0.009, respectively). At a cutoff of 0.5 mg/L, D-d showed superior predictive value for AAD and IMH (sensitivity 99% and 100%, respectively; specificity 67% for both), than for PAU (sensitivity 64%, specificity 67%). Both admission and in-hospital D-d were predictive for in-hospital mortality using a cutoff of 9.0 mg/L (area under the curve 0.68 and 0.78; p=0.019 and p=0.009, respectively). On multivariate analysis, in-hospital D-d ⩾9 mg/L (odds ratio [OR] 5.60, p=0.022), mesenteric ischemia/infarction (OR 5.64, p=0.038) and hypotension/shock/tamponade (OR 11.76, p<0.001) were independent predictors of in-hospital mortality. In contrast, at 3-year follow-up D-d levels did not affect survival. CONCLUSIONS: At a cutoff of 0.5 mg/L, D-d was a reliable diagnostic marker for AAD and IMH, but not for PAU. A mean D-d ⩾9 mg/L during the hospitalization was an independent predictor of in-hospital mortality, but did not affect survival at follow-up.
Authors: Andrew S Miller; Kathryn Boyce; Benjamin Box; Matthew D Clarke; Sarah E Duff; Niamh M Foley; Richard J Guy; Lisa H Massey; George Ramsay; Dominic A J Slade; James A Stephenson; Phil J Tozer; Danette Wright Journal: Colorectal Dis Date: 2021-02 Impact factor: 3.917
Authors: Carlos Ferrera; Isidre Vilacosta; Beatriz Cabeza; Javier Cobiella; Isaac Martínez; Melchor Saiz-Pardo Sanz; Ana Bustos; Francisco Javier Serrano; Luis Maroto Journal: Vasc Health Risk Manag Date: 2020-06-08