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A Novel Serum Biomarker Model to Discriminate Aortic Dissection from Coronary Artery Disease
Peijiang Lu1, Xin Feng1, Rui Li1
1Division of Cardiothoracic and Vascular Surgery, Sino-Swiss Heart-Lung Transplantation Institute, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Insights
Iron metabolism biomarkers can help differentiate aortic dissection (AD) from coronary artery disease (CAD). A new FLUTHE model shows high accuracy in diagnosing AD and CAD, especially after 72 hours from symptom onset.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Diagnostic Biomarkers
Background:
- Aortic dissection (AD) misdiagnosis has severe consequences.
- Current diagnostic methods lack effective serological indicators for differentiating AD from coronary artery disease (CAD).
- Iron metabolism's association with AD suggests its potential diagnostic utility.
Purpose of the Study:
- To investigate the efficacy of iron metabolism biomarkers in distinguishing AD from CAD.
- To develop a novel diagnostic model for AD and CAD.
Main Methods:
- Retrospective, multicenter cross-sectional study.
- Collected biomarkers of iron metabolism, liver function, kidney function, and other biochemistry tests.
- Applied logistic regression analysis for model development.
Main Results:
- Six serum biomarkers (serum iron, LDL, uric acid, transferrin, HDL, eGFR) formed the FLUTHE model.
- FLUTHE demonstrated high diagnostic performance: 0.954 sensitivity and 0.905 specificity.
- Effective for differentiating AD and CAD over 72 hours post-symptom onset.
Conclusions:
- Iron metabolism plays a significant role in AD diagnosis and differentiation.
- The FLUTHE model offers an efficient, safe, and economical approach for AD/CAD diagnosis.
- FLUTHE is particularly valuable for patients presenting >72 hours after symptom onset.
Background:
The misdiagnosis of aortic dissection (AD) can lead to a catastrophic prognosis. There is currently a lack of stable serological indicators with excellent efficacy for the differential diagnosis of AD and coronary artery disease (CAD). A recent study has shown an association between AD and iron metabolism. Thus, we investigated whether iron metabolism could discriminate AD from CAD.
Methods:
This retrospective and multicenter cross-sectional study investigated the efficacy of biomarkers of iron metabolism for the differential diagnosis of AD. We collected biomarkers of iron metabolism, liver function, kidney function, and other biochemistry test, and further, logistic regression analysis was applied.
Results:
Between Oct. 8, 2020, and Mar. 1, 2021, we recruited 521 patients diagnosed with AD, CAD, and other cardiovascular diseases (OCDs) with the main symptoms of chest and back pain and assigned them to discovery set (n = 330) or validation set (n = 191). We found that six serum biomarkers, including serum iron, low-density lipoprotein, uric acid, transferrin, high-density lipoprotein, and estimated glomerular filtration rate, can serve as a novel comprehensive indicator (named FLUTHE) for the differential diagnosis of AD and CAD with a sensitivity of 0.954 and specificity of 0.905 to differentially diagnose AD and CAD more than 72 h past symptom onset.
Conclusion:
Our findings provide insight into the role of iron metabolism in diagnosing and distinguishing AD, which might in the future be a key component in AD diagnosis. Furthermore, we establish a novel model named "FLUTHE" with higher efficiency, safety, and economy, especially for patients with chest pain for more than 72 h.
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