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A rapid bedside D-dimer assay (cardiac D-dimer) for screening of clinically suspected acute aortic dissection

Koichi Akutsu1, Naoki Sato, Takeshi Yamamoto

  • 1Intensive and Coronary Care Unit, Nippon Medical School, Tokyo, Japan. koichi-a@nms.ac.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|March 26, 2005
PubMed

Insights

A rapid bedside D-dimer (DD) assay effectively rules out acute aortic dissection (AAD) in patients with chest pain, showing 100% sensitivity. Elevated DD levels with high blood pressure suggest AAD.

Area of Science:

  • Cardiovascular Medicine
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Diagnosis of acute aortic dissection (AAD) lacks rapid laboratory tests.
  • Prospective study to evaluate a rapid bedside D-dimer (DD) assay for AAD detection.

Purpose of the Study:

  • To determine the clinical utility of a rapid bedside D-dimer (DD) assay for diagnosing acute aortic dissection (AAD).

Main Methods:

  • Prospective recruitment of patients with suspected AAD.
  • Measurement of D-dimer (DD) levels using a rapid bedside assay.
  • Group division based on computed tomography findings: AAD (n=30) vs. non-AAD (n=48).

Main Results:

  • Median DD levels were significantly higher in the AAD group (1.80 microg/ml) compared to the non-AAD group (0.42 microg/ml).
  • The assay demonstrated 100% sensitivity and 100% negative predictive value for AAD with DD levels up to 0.5 microg/ml.
  • A combination of elevated DD (>0.5 microg/ml) and systolic blood pressure (≥180 mmHg) yielded an 86% positive predictive value for AAD.

Conclusions:

  • The rapid bedside D-dimer (DD) assay is highly sensitive for early exclusion of acute aortic dissection (AAD).
  • Elevated DD levels combined with high systolic blood pressure (≥180 mmHg) indicate a high probability of AAD.
Abstract

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