To investigate the early diagnostic and prognostic value of plasma D-dimer level in acute aortic dissection.

Data of totally 500 acute chest pain patients were studied , in which 250 cases were in group of acute aortic dissection (group AAD) confirmed by aortic computerized tomographic angiography (CTA) or cardiac ultrasonography, and the rest 250 cases were in non AAD group (group control). The D-dimer test was performed in all patients within 72 hours after onset of chest pain, and comparison of plasma D-dimer concentration was carried out between two groups. The D-dimer diagnostic value in AAD was analyzed by plotting the receiver operating characteristic (ROC) curve. According to AAD patients with aortic CTA findings, the whole aortic artery was divided into four segments by the major vascular branches, and the false lumen area was measured by degree score, the relationship between the score and D-dimer level were analyzed. To study the prognostic value of D-dimer in AAD, the comparison of D-dimer level was carried out between survival group and death group, and the AAD patients were further stratified by the surgery and Stanford type.

The plasma D-dimer concentrations in AAD group were significantly higher than those in controls (P<0.01). The sensitivity, specificity, positive predictive value and negative predictive value of D-dimer (>1.14 mg/L) in the diagnosis of AAD were 81.2%, 79.39%, 74.63% and 72.4% respectively, and the area under the ROC curve was 0.083. The elevated level of D-dimer was positively correlated with the extent of AAD false lumen(Spearman-Rho=0.418, P<0.01). D-dimer levels in the death group were higher than those in the survival group.

D-dimer may be a valuable biomarker in early diagnosis of AAD. The elevated level of D-dimer was useful to evaluate the extent of the dissection and prognosis of AAD.

Aortic dissection; D-dimer; Diagnosis; Prognosis; Chest Pain