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

AimTo test the utility of plasma D-dimer determination in the diagnosis of acute aortic dissection (AAD), in particular with respect to its high negative predictive value reported in the relevant literature.MethodWe performed a retrospective analysis of the medical records of 76 patients admitted for acute chest pain of unclear etiology (of this number, 41 AAD patients and 35 controls with undocumented AAD) who had their plasma D-dimer levels determined on admission. Using imaging techniques, AAD was documented in the 41 AAD patients by computer tomography (80%), esophageal echocardiography (18%), aortography or based on pathological–anatomical autopsy findings (one patient each).ResultsThe finding of increased D-dimer levels (>0.5 mg/l FEU) showed 100% sensitivity, i.e., a 100% negative predictive value, 37% specificity, 65% positive predictive value, and 71% accuracy in diagnosing AAD. Elevated D-dimer levels correlated with more extensive involvement of the aorta consistent with the type of dissection using De Bakey's classification (II, III, I; r=0.63; p<0.01). No correlation was found between plasma D-dimer levels and chest pain duration.ConclusionDetermination of plasma D-dimer levels seems to be a useful tool in early diagnosis of AAD. Plasma D-dimer levels <0.5 mg/l FEU virtually exclude the presence of AAD.