Aortic dissection laboratory findings

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Aortic dissection Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Aortic dissection from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

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Echocardiography and Ultrasound

CT scan

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Treatment

Medical Therapy

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Secondary Prevention

Special Scenarios

Management during Pregnancy

Case Studies

Case #1


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Sahar Memar Montazerin, M.D.[2] Cafer Zorkun, M.D., Ph.D. [3] Laith Adnan Allaham, M.D.[4]

Overview

There is no particular laboratory findings for the diagnosis of aortic dissection. Possible laboratory findings associated with aortic dissection may include troponin elevation, CK-MB elevation, hematuria, and etc. There has been reports of using a smooth muscle myosin heavy chain immunoassay to help diagnose aortic dissection.

Laboratory Findings

There is no particular laboratory findings for the diagnosis of aortic dissection. Possible laboratory findings associated with aortic dissection may include:

D-dimer

  • Aortic dissection is more likely in the case of elevated D-dimer levels. It worth mentioning that compared to other causes of D-dimer elevation, aortic dissection leads to immediate rather than gradual increase in D-dimer level. D-dimer elevation has highest diagnostic value in the first hour of symptom presentation.[1]

Cardiac Biomarkers

  • Troponin elevation may be observed in approximately 25% of patients with aortic dissection type A. It may be the result of hemodynamic stress and is not associated with poorer prognosis.[2]
  • The presence of an elevated CK MB may indicate the presence of concurrent acute myocardial infarction.[3]

Biomarker Studies

Urinalysis

2014 ESC Guidelines on The Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT[7]

Diagnostic Work-up of Aortic Dissection[7]

Class IIa
"In case of suspicion of AAS, the interpretation of biomarkers should always be considered along with the pretest clinical probability.(Level of Evidence:C)"

Low Clinical Probability of Aortic Dissection[7]

Class IIa
"In case of low clinical probability of AAS, negative Ddimer levels should be considered as ruling out the diagnosis. (Level of Evidence:B)"[8][9][10][11]

Intermediate Clinical Probability of Aortic Dissection[7]

Class IIa
"In case of intermediate clinical probability of AAS with a positive (point-of-care) Ddimer test, further imaging tests should be considered.(Level of Evidence:B)"[8][9]

High Clinical Probability of Aortic Dissection[7]

Class III
"In patients with high probability (risk score 2 or 3) of AD, testing of D-dimers is not recommended. (Level of Evidence:C)"

References

  1. Rogers, Adam M.; Hermann, Luke K.; Booher, Anna M.; Nienaber, Christoph A.; Williams, David M.; Kazerooni, Ella A.; Froehlich, James B.; O'Gara, Patrick T.; Montgomery, Daniel G.; Cooper, Jeanna V.; Harris, Kevin M.; Hutchison, Stuart; Evangelista, Arturo; Isselbacher, Eric M.; Eagle, Kim A. (2011). "Sensitivity of the Aortic Dissection Detection Risk Score, a Novel Guideline-Based Tool for Identification of Acute Aortic Dissection at Initial Presentation". Circulation. 123 (20): 2213–2218. doi:10.1161/CIRCULATIONAHA.110.988568. ISSN 0009-7322.
  2. BONNEFOY, Eric; GODON, Patrick; KIKORIAN, Gilbert; CHABAUD, Sylvie; TOUBOUL, Paul (2005). "Significance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta". Acta Cardiologica. 60 (2): 165–170. doi:10.2143/AC.60.2.2005027. ISSN 0001-5385.
  3. Davidson, E. (1988). "Elevated serum creatine kinase levels. An early diagnostic sign of acute dissection of the aorta". Archives of Internal Medicine. 148 (10): 2184–2186. doi:10.1001/archinte.148.10.2184. ISSN 0003-9926.
  4. Suzuki, T. (1997). "Biochemical Diagnosis of Acute Aortic Damage - Diagnosis of Aortic Dissection and Traumatic Aortic Rupture Using an Immunoassay of Smooth Muscle Myosin Heavy Chain": 3–10. doi:10.1007/978-3-642-60735-6_1.
  5. Suzuki, Toru (2000). "Diagnostic Implications of Elevated Levels of Smooth-Muscle Myosin Heavy-Chain Protein in Acute Aortic Dissection: The Smooth Muscle Myosin Heavy Chain Study". Annals of Internal Medicine. 133 (7): 537. doi:10.7326/0003-4819-133-7-200010030-00013. ISSN 0003-4819.
  6. Kodama, Koichi; Noda, Toru; Motoi, Isamu (2013). "Nutcracker phenomenon: An unusual presentation of acute aortic dissection". Indian Journal of Urology. 29 (1): 67. doi:10.4103/0970-1591.109990. ISSN 0970-1591.
  7. 7.0 7.1 7.2 7.3 7.4 Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). "2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)". Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID 25173340.
  8. 8.0 8.1 Eggebrecht, Holger; Mehta, Rajendra H.; Metozounve, Huguette; Huptas, Sebastian; Herold, Ulf; Jakob, Heinz G.; Erbel, Raimund (2008). "Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement". Journal of Endovascular Therapy. 15 (2): 135–143. doi:10.1583/07-2284.1. ISSN 1526-6028.
  9. 9.0 9.1 Sutherland, Alexander; Escano, Jude; Coon, Troy P. (2008). "D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature". Annals of Emergency Medicine. 52 (4): 339–343. doi:10.1016/j.annemergmed.2007.12.026. ISSN 0196-0644.
  10. Suzuki, Toru; Bossone, Eduardo; Sawaki, Daigo; Jánosi, Rolf Alexander; Erbel, Raimund; Eagle, Kim; Nagai, Ryozo (2013). "Biomarkers of aortic diseases". American Heart Journal. 165 (1): 15–25. doi:10.1016/j.ahj.2012.10.006. ISSN 0002-8703.
  11. Taylor, R. Andrew; Iyer, Neel S. (2013). "A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection". The American Journal of Emergency Medicine. 31 (7): 1047–1055. doi:10.1016/j.ajem.2013.03.039. ISSN 0735-6757.

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