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Circulating biomarkers in acute aortic dissection versus acute myocardial infarction: a systematic review
Maria L Galhano1, Filipa Jácome2, Jennifer Y Huynh3
1UnIC@RISE-Health, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal - mlaura.galhano@sapo.pt.
Insights
This review explored biomarkers for diagnosing acute aortic dissection (AAD) versus acute myocardial infarction (AMI). Few biomarkers showed diagnostic validity, highlighting the need for higher-quality studies.
Area of Science:
- Cardiology
- Biomarker Discovery
- Diagnostic Accuracy
Background:
- Acute aortic dissection (AAD) and acute myocardial infarction (AMI) are critical cardiovascular emergencies requiring accurate and timely diagnosis.
- D-dimers are commonly used, but this review focuses on alternative circulatory biomarkers for differentiating AAD from AMI.
- Identifying specific biomarkers is crucial for improving diagnostic strategies and patient outcomes.
Approach:
- A systematic review following PRISMA guidelines was conducted.
- Databases searched included PubMed, EMBASE, and Scopus from inception to May 2023.
- Included studies measured blood/plasma/serum biomarkers in adult patients with AAD compared to AMI, excluding chronic cases and studies lacking control groups.
Key Points:
- Seven studies were included, identifying various biomarkers including metabolomics and extracellular matrix markers.
- Most identified biomarkers lacked sufficient diagnostic validity (sensitivity and specificity).
- Six studies found significant differences in six biomarkers between AAD and AMI groups.
Conclusions:
- A wide range of molecules have been investigated as potential diagnostic markers for AAD versus AMI.
- There is a need for higher-quality research to establish the diagnostic validity of these biomarkers.
- Future studies should explore the synergistic diagnostic value of identified molecules.
Introduction:
This systematic review aimed to discuss the current knowledge of possibly useful circulatory biomarkers (other than D-dimers) in the diagnosis of patients with an acute aortic dissection (AAD), to distinguish these patients from patients with Acute Myocardial Infarction (AMI).
Evidence Acquisition:
This study followed the PRISMA guidelines. The databases PubMed, EMBASE and Scopus were systematically searched from inception to May 2023. Studies were included if they presented measurements of biomarker(s) in the blood/plasma/serum samples from adult patients with AAD versus AMI. Articles were excluded if aortic dissection was subacute or chronic (>14 days), if they lack a control group (AMI), or if they were animal studies, revisions, or editorials. The main outcome was the identification of biomarkers that exhibited diagnostic potential to differentiate patients with AAD versus AMI.
Evidence Synthesis:
The research query resulted in 1342 articles after the removal of duplicates, from which seven were included in the systematic review. The biomarkers identified included general blood assessment, metabolomics, products of the degradation of fibrin, extracellular matrix markers and an ischemia-associated molecule. Most studies lack diagnostic validity such as sensitivity and specificity. In six studies, the concentration of a total of six biomarkers showed significative differences between AAD and AMI group.
Conclusions:
A great heterogeneity of molecules has been studied as putative diagnostic markers of AAD versus AMI. Studies of better quality are needed, presenting the diagnostic validity of the molecules under analysis and the putative synergic diagnostic value of the molecules identified so far.
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