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      Changes of Serum D-Dimer, NT-proBNP, and Troponin I Levels in Patients with Acute Aortic Dissection and the Clinical Significance

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          Abstract

          Objective

          To investigate the changes in blood D-dimer (D-D), high-sensitivity troponin I (hs-cTnI), and N-terminal B-type brain natriuretic peptide (NT-proBNP) levels in patients with acute aortic dissection (AAD) and its clinical significance.

          Methods

          Forty patients with AAD diagnosed in our hospital from January 2018 to December 2019 were selected as the observation group, and 40 patients with chest pain and non-AAD treated in our hospital during the same period were included in the control group. The patients were subdivided into a death group and a survival group as per the prognosis. The clinical symptoms and signs of the two groups of patients upon admission were observed, and the levels of D-D, hs-cTnI, and NT-proBNP were determined. The differences in clinical data, plasma D-D, hs-cTnI, and NT-proBNP levels between the two groups of patients were analyzed.

          Results

          The clinical data and physical signs were homogeneous between the two groups ( P > 0.05), while a significant elevation in the level of hs-cTnI in the control group was observed 24 h after admission ( P < 0.05). The observation group showed significantly higher levels of D-D, NT-proBNP, and hs-cTnI than the control group ( P < 0.05). The prevalence and surgical cure rate of Stanford A in the survival group were significantly lower in contrast with the death group, with an obvious higher intervention cure rate in the survival group. Higher D-dimer and NT-proBNP levels were identified at 24 h after admission versus upon admission, and the death group had a greater increase of D-dimer and NT-proBNP levels.

          Conclusion

          Clinical symptoms and signs are insufficient to constitute a diagnosis of AAD, whereas the elevated expression levels of D-D, hs-cTnI, and NT-proBNP demonstrated great potential for the diagnosis and prognosis of AAD.

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          Most cited references22

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          The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.

          P. Hagan, C. A. Nienaber, E. Isselbacher … (2000)
          Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. To assess the presentation, management, and outcomes of acute aortic dissection. Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. A total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom had type A dissection. Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%. Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.
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            Management of acute aortic dissection.

            Christoph Nienaber, Rachel Clough (2015)
            A new appraisal of the management of acute aortic dissection is timely because of recent developments in diagnostic strategies (including biomarkers and imaging), endograft design, and surgical treatment, which have led to a better understanding of the epidemiology, risk factors, and molecular nature of aortic dissection. Although open surgery is the main treatment for proximal aortic repair, use of endovascular management is now established for complicated distal dissection and distal arch repair, and has recently been discussed as a pre-emptive measure to avoid late complications by inducing aortic remodelling.
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              A Test in Context: D-Dimer

              Jeffrey Weitz, James C Fredenburgh, John W Eikelboom (2017)
              D-dimer is a soluble fibrin degradation product that results from ordered breakdown of thrombi by the fibrinolytic system. Numerous studies have shown that D-dimer serves as a valuable marker of activation of coagulation and fibrinolysis. Consequently, D-dimer has been extensively investigated for the diagnosis of venous thromboembolism (VTE) and is used routinely for this indication. In addition, D-dimer has been evaluated for determining the optimal duration of anticoagulation in VTE patients, for diagnosing and monitoring disseminated intravascular coagulation, and as an aid in the identification of medical patients at high risk for VTE. Thus, quantification of D-dimer levels serves an important role in guiding therapy. This review: 1) describes how D-dimer is generated; 2) reviews the assays used for its detection; and 3) discusses the role of D-dimer determination in these various conditions.
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                Author and article information

                Contributors
                Zhen Teng:
                ORCID: https://orcid.org/0000-0002-0211-8147
                Journal
                Journal ID (nlm-ta): Evid Based Complement Alternat Med
                Journal ID (iso-abbrev): Evid Based Complement Alternat Med
                Journal ID (publisher-id): ECAM
                Title: Evidence-based Complementary and Alternative Medicine : eCAM
                Publisher: Hindawi
                ISSN (Print): 1741-427X
                ISSN (Electronic): 1741-4288
                Publication date Collection: 2022
                Publication date (Electronic): 8 August 2022
                Publication date PMC-release: 8 August 2022
                Volume: 2022
                Electronic Location Identifier: 8309505
                Affiliations
                1Cardiovascular Department 4, Cangzhou Central Hospital, Cangzhou, China
                2Cardiovascular Department 3, Cangzhou Central Hospital, Cangzhou, China
                3Catheterization Laboratory, Cangzhou Central Hospital, Cangzhou, China
                Author notes

                Academic Editor: Tian Jiao Wang

                Author information
                https://orcid.org/0000-0002-0211-8147
                Article
                DOI: 10.1155/2022/8309505
                PMC ID: 9377895
                SO-VID: f7234740-7742-4d4b-8778-c7e9b52b0302
                Copyright © Copyright © 2022 Zexiang Xu et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 10 June 2022
                Date revision received : 5 July 2022
                Date accepted : 9 July 2022
                Funding
                Funded by: Cangzhou City Key R&D Program Guidance Project
                Award ID: 204106103
                Categories
                Subject: Research Article

                ScienceOpen disciplines: Complementary & Alternative medicine
                Data availability:
                ScienceOpen disciplines: Complementary & Alternative medicine

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