Validation of the diagnostic utility of <scp>D</scp>-dimer measurement in patients with acute aortic syndrome

Kotani, Yuki; Toyofuku, Mamoru; Tamura, Takashi; Shimada, Kotaro; Matsuura, Yushi; Tawa, Hiroyuki; Uchikawa, Munehiro; Higashi, Sonoko; Fujimoto, Jumpei; Yagita, Kaoru; Sato, Fumitaka; Atagi, Yuichiro; Hamasaki, Toshiaki; Tsujimoto, Toshihide; Chishiro, Takao

doi:10.1177/2048872616652261

Cited by 24 publications

(36 citation statements)

References 19 publications

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“…Within 680 studies identified by the systematic database research, 12 studies were selected for full-text review ( Figure 1) and four studies met all the inclusion criteria. 16,[28][29][30] Three studies were designed to investigate the diagnostic test characteristics of ADD-RS plus DD < 500 ng/mL, [28][29][30] and one investigated the integration of ADD-RS with DD < DD age-adj . 16 The study characteristics are summarized in Table 2 and the final diagnoses of the participant patients are detailed in Table S3.…”

Section: Literature Searchmentioning

confidence: 99%

“…16,[28][29][30] Three studies were designed to investigate the diagnostic test characteristics of ADD-RS plus DD < 500 ng/mL, [28][29][30] and one investigated the integration of ADD-RS with DD < DD age-adj . 16 The study characteristics are summarized in Table 2 and the final diagnoses of the participant patients are detailed in Table S3. The case mix of AASs was similar among studies, with acute aortic dissection representing the most frequent subtype and intramural aortic hematoma or penetrating aortic ulcer accounting for most of the other cases.…”

Section: Literature Searchmentioning

confidence: 99%

“…In Gorla et al, 29 patients were enrolled if they were admitted to the ED for chest pain and if they were 28 Gorla, 2017 29 Kotani, 2017 16 Nazerian subjected to a DD assay. These criteria could bias against atypical presentations not involving chest pain.…”

Section: Literature Searchmentioning

confidence: 99%

“…Since the actual number of patients subjected to advanced imaging is unknown and clinical case adjudication was not based on a prespecified follow-up, observed sensitivity could be raised due to differential verification bias. In the study by Kotani et al, 16 patients were also enrolled if they presented with acute chest pain and if they received a DD assay. The exact time interval from symptom onset to sampling was not presented, and the DD assay was used per a prespecified hospital protocol not detailed in the article.…”

Section: Literature Searchmentioning

confidence: 99%

“…15 Two studies have reported that also for AASs, DD age-adj may increase specificity with a small trade-off in sensitivity. 16,17 A single cutoff for PE and AASs could be very practical, as both conditions are invariably considered in differential diagnosis in patients with truncal pain and both imply decision on CTA. 18 The rationale of integrating ADD-RS with DD testing is that very few cases of AASs are predicted to occur in patients with ADD-RS = 0 or ≤ 1 and a negative DD test result.…”

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confidence: 99%

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Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out Of Suspected Acute Aortic Syndromes

Bima

Pivetta

Nazerian

et al. 2020

Academic Emergency Medicine

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Objectives: In patients at low clinical probability of acute aortic syndromes (AASs), decision on advanced aortic imaging is cumbersome. Integration of the aortic dissection detection risk score (ADD-RS) with D-dimer (DD) provides a potential pipeline for standardized diagnostic rule-out. We systematically reviewed and summarized supporting data. Methods: Cross-sectional studies assessing integration of ADD-RS with DD for diagnosis of AASs were identified on MEDLINE, EMBASE and Web Of Science databases. Two reviewers independently screened articles, assessed quality, and extracted data. The quality of design and reporting was evaluated with the QUADAS-2 and STARD tools. Individual patient data were obtained, to allow analysis of both conventional (500 ng/mL) and age-adjusted (DD age-adj) DD cutoffs. Data were summarized for four diagnostic strategies combining ADD-RS = 0 or ≤ 1, with DD < 500 ng/mL or < DD age-adj. The statistical heterogeneity of the diagnostic variables was estimated with Higgins' I 2. Pooled values were calculated for variables showing nonsignificant heterogeneity. Results: After screening of 680 studies, four articles (including a total of 3,804 patients) met inclusion criteria. One prospective study provided a low risk of bias/applicability concerns, while methodologic limitations were found in the other three retrospective studies. Statistical heterogeneity was negligible for sensitivity and negative likelihood ratio (LR) values and significant for specificity and positive LR values of all diagnostic strategies. Pooled sensitivity was 99.

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Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

mentioning

confidence: 99%

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Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out Of Suspected Acute Aortic Syndromes

Bima

Pivetta

Nazerian

et al. 2020

Academic Emergency Medicine

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Diagnosis and management of acute aortic syndromes in the emergency department

et al. 2020

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Acute aortic syndromes (AASs) are deadly cardiovascular emergencies involving the thoracic aorta.AASs are relatively rare conditions, have unspecific signs and symptoms (including truncal pain, syncope, neurologic deficit and limb ischemia) and require contrast-enhanced tomography angiography (CTA) of the chest and abdomen for conclusive diagnosis and subsequent therapeutic planning. In the Emergency Department (ED), most patients with potential signs/symptoms of AASs are finally found affected by other alternative diagnoses. Hence, misdiagnosis and delayed diagnosis of AASs are major concerns. In critically ill patients, decision to perform CTA is usually straightforward, as exam benefits largely outweigh risks. In patients with ST-tract elevation on ECG, suspected primary ischemic stroke and in stable patients (representing the most prevalent ED scenarios), proper selection of patients necessitating CTA is cumbersome, due to concurrent risks of misdiagnosis and over-testing. Available studies support an algorithm integrating clinical probability assessment, bedside echocardiography and D-dimer (if the clinical probability is not high). Therapeutic management includes medical therapy for all patients including an opioid and anti-impulse drugs (a beta-blocker and a vasodilator), targeting a heart rate of 60 bpm and systolic blood pressure of 100-120 mmHg. Patients with AASs involving the ascending aorta are likely candidate for urgent surgery, and complicated type B AASs (severe aortic dilatation, impending or frank rupture, organ malperfusion, refractory pain, severe hypertension) necessitate evaluation for urgent endovascular treatment. For uncomplicated type B AASs, optimal medical therapy is the current standard of care.

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D-dimer measurement is useful irrespective of time from the onset of acute aortic syndrome symptoms

Otani

Abe

Ichiba

et al. 2023

The American Journal of Emergency Medicine

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Validation of the diagnostic utility of D-dimer measurement in patients with acute aortic syndrome

Cited by 24 publications

References 19 publications

Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out Of Suspected Acute Aortic Syndromes

Systematic Review of Aortic Dissection Detection Risk Score Plus D‐dimer for Diagnostic Rule‐out Of Suspected Acute Aortic Syndromes

Diagnosis and management of acute aortic syndromes in the emergency department

D-dimer measurement is useful irrespective of time from the onset of acute aortic syndrome symptoms

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