What's new in the biochemical diagnosis of acute aortic dissection: problems and perspectives

Acute aortic dissection of the thoracic aorta represents a medical emergency that, despite its rare occurrence, is characterized by severe morbidity and mortality. Prompt diagnosis is the key to a desired outcome. According to current clinical data, diagnosis is mostly based on a high index of suspicion and diagnostic imaging and less on clinical manifestations. On the other hand, a biochemical approach to the entity is still falling short in terms of diagnostic practice, although optimistic efforts are being made towards the development of such methods. Myocin heavy-chain concentrations, D-dimer levels, and soluble elastin fragment measurement are some of the new promising tools emerging in the battle of acute diagnosis. Despite their potentials, all three still need to be reevaluated. More prospective clinical trials should be performed so as to improve and ensure a biochemical diagnostic method for acute aortic dissection of high sensitivity and specificity and thus of great clinical value. Search of the Literature: Two reviewers performed a literature search, identified the relevant studies to be included in this review, and extracted the data. Relevant studies for inclusion in this review were identified through PubMed as well as from references of the initially found articles. The search terms used were "myocin-heavy chains", "D-dimers", "soluble elastin fragments", "biochemical diagnosis", "aortic dissection", "sensitivity", "specificity", and "performance characteristics".