Aortic dissection laboratory findings: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
(/* 2014 ESC Guidelines on The Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT){{cite journal|title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases|journal=European Heart Journal|volume=35|issue=41|year=2014|pages=2873–29...) |
||
| Line 20: | Line 20: | ||
*[[Hematuria]] may be present and may indicate the presence of [[renal infarction]].<ref name="KodamaNoda2013">{{cite journal|last1=Kodama|first1=Koichi|last2=Noda|first2=Toru|last3=Motoi|first3=Isamu|title=Nutcracker phenomenon: An unusual presentation of acute aortic dissection|journal=Indian Journal of Urology|volume=29|issue=1|year=2013|pages=67|issn=0970-1591|doi=10.4103/0970-1591.109990}}</ref> | *[[Hematuria]] may be present and may indicate the presence of [[renal infarction]].<ref name="KodamaNoda2013">{{cite journal|last1=Kodama|first1=Koichi|last2=Noda|first2=Toru|last3=Motoi|first3=Isamu|title=Nutcracker phenomenon: An unusual presentation of acute aortic dissection|journal=Indian Journal of Urology|volume=29|issue=1|year=2013|pages=67|issn=0970-1591|doi=10.4103/0970-1591.109990}}</ref> | ||
== 2014 ESC Guidelines on The Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT | == 2014 ESC Guidelines on The Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT<ref name="pmid25173340">{{cite journal |vauthors=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 |title=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) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref> == | ||
===Diagnostic Work-up of Aortic Dissection=== | ===Diagnostic Work-up of Aortic Dissection<ref name="pmid25173340">{{cite journal |vauthors=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 |title=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) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>=== | ||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background: | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor=" | |bgcolor="LemonChiffon"|<nowiki>"</nowiki>Laboratory tests should always be interpreted along with pretest clinical probability of acute aortic syndrome (AAS). ''([[ESC guidelines classification scheme#Level of Evidence|Level of Evidence:C]])''<nowiki>"</nowiki> | ||
|} | |} | ||
===Low Clinical Probability of Aortic Dissection<ref name="pmid25173340">{{cite journal |vauthors=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 |title=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) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>=== | |||
{|class="wikitable" | {|class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"| | |bgcolor="LemonChiffon"|"A negative D-dimer test in case of a low clinical probability of acute aortic syndrome (AAS) should be considered as the ruling out diagnostic test. (Level of Evidence:B)"<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref><ref name="SuzukiBossone2013">{{cite journal|last1=Suzuki|first1=Toru|last2=Bossone|first2=Eduardo|last3=Sawaki|first3=Daigo|last4=Jánosi|first4=Rolf Alexander|last5=Erbel|first5=Raimund|last6=Eagle|first6=Kim|last7=Nagai|first7=Ryozo|title=Biomarkers of aortic diseases|journal=American Heart Journal|volume=165|issue=1|year=2013|pages=15–25|issn=00028703|doi=10.1016/j.ahj.2012.10.006}}</ref><ref name="TaylorIyer2013">{{cite journal|last1=Taylor|first1=R. Andrew|last2=Iyer|first2=Neel S.|title=A decision analysis to determine a testing threshold for computed tomographic angiography and d-dimer in the evaluation of aortic dissection|journal=The American Journal of Emergency Medicine|volume=31|issue=7|year=2013|pages=1047–1055|issn=07356757|doi=10.1016/j.ajem.2013.03.039}}</ref> | ||
|} | |||
===Intermediate Clinical Probability of Aortic Dissection<ref name="pmid25173340">{{cite journal |vauthors=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 |title=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) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>=== | |||
{|class="wikitable" | |||
|- | |- | ||
| | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|"A positive D-dimer test along with an intermediate clinical probability of acute aortic syndrome (AAS) should warrant further imaging studies. (Level of Evidence:B)"<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref> | |bgcolor="LemonChiffon"|"A positive D-dimer test along with an intermediate clinical probability of acute aortic syndrome (AAS) should warrant further imaging studies. (Level of Evidence:B)"<ref name="EggebrechtMehta2008">{{cite journal|last1=Eggebrecht|first1=Holger|last2=Mehta|first2=Rajendra H.|last3=Metozounve|first3=Huguette|last4=Huptas|first4=Sebastian|last5=Herold|first5=Ulf|last6=Jakob|first6=Heinz G.|last7=Erbel|first7=Raimund|title=Clinical Implications of Systemic Inflammatory Response Syndrome Following Thoracic Aortic Stent-Graft Placement|journal=Journal of Endovascular Therapy|volume=15|issue=2|year=2008|pages=135–143|issn=1526-6028|doi=10.1583/07-2284.1}}</ref><ref name="SutherlandEscano2008">{{cite journal|last1=Sutherland|first1=Alexander|last2=Escano|first2=Jude|last3=Coon|first3=Troy P.|title=D-dimer as the Sole Screening Test for Acute Aortic Dissection: A Review of the Literature|journal=Annals of Emergency Medicine|volume=52|issue=4|year=2008|pages=339–343|issn=01960644|doi=10.1016/j.annemergmed.2007.12.026}}</ref> | ||
|} | |} | ||
===High Clinical Probability of Aortic Dissection<ref name="pmid25173340">{{cite journal |vauthors=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 |title=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) |journal=Eur. Heart J. |volume=35 |issue=41 |pages=2873–926 |date=November 2014 |pmid=25173340 |doi=10.1093/eurheartj/ehu281 |url=}}</ref>=== | |||
{|class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:Red"|[[ESC guidelines classification scheme#Classification of Recommendations|Class III]] | |||
|- | |||
|bgcolor="Red"|"In Patients with high clinical probability of aortic dissection (risk score 2 or 3), D-dimer evaluation is not recommended. (Level of Evidence:C)" | |||
|} | |||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 23:10, 6 December 2019
|
Aortic dissection Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Special Scenarios |
|
Case Studies |
|
|
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]
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 elevation
- Troponin elevation
- CK-MB elevation
- Hematuria
D-dimer
- Aortic dissection is more likely in the case of elevated D-dimer levels. It worths 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
- There has been reports of using a smooth muscle myosin heavy chain immunoassay to help diagnose aortic dissection.[4][5]
Urinalysis
- Hematuria may be present and may indicate the presence of renal infarction.[6]
2014 ESC Guidelines on The Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT[7]
Diagnostic Work-up of Aortic Dissection[7]
| Class IIa |
| "Laboratory tests should always be interpreted along with pretest clinical probability of acute aortic syndrome (AAS). (Level of Evidence:C)" |
Low Clinical Probability of Aortic Dissection[7]
| Class IIa |
| "A negative D-dimer test in case of a low clinical probability of acute aortic syndrome (AAS) should be considered as the ruling out diagnostic test. (Level of Evidence:B)"[8][9][10][11] |
Intermediate Clinical Probability of Aortic Dissection[7]
| Class IIa |
| "A positive D-dimer test along with an intermediate clinical probability of acute aortic syndrome (AAS) should warrant further imaging studies. (Level of Evidence:B)"[8][9] |
High Clinical Probability of Aortic Dissection[7]
| Class III |
| "In Patients with high clinical probability of aortic dissection (risk score 2 or 3), D-dimer evaluation is not recommended. (Level of Evidence:C)" |
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 7.0 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.
- ↑ 8.0 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.
- ↑ 9.0 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.
- ↑ 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.
- ↑ 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.