The Determination Of D-dimmer In The Diagnosis And Prognosis Of Acute Aortic Dissection

Background:Acute aortic dissection (AAD) is one of the cardiovascular emergency disease.It’s annual incidence is about5-30/1000000. At the same time, it can be rapidlyforward to death, with the complex dangerous condition and quick progression. AADpatients’s clinical symptom is various, and it is difficult to identify compared withacute coronary syndrome (ACS) and pulmonary embolism (PE). At present, AADdiagnosis mainly depends on imaging methods, such as CT angiography (CTA),magnetic resonance angiography (MRA), Cardiovascular echocardiography etc.These imaging examination methods can be used to observed the area of interliningcrevasse and involvement clearly. But they are time-consuming and expensive. Somuch more, they need to move patients when text, which may result into harm tobody. In this study, we investigate a rapid, accurate laboratory examination method topreliminarily estimate the disease.Objective:To explore the value of D-dimmer level in the diagnosis, classification andprognosis of acute aortic dissection(AAD),and to provide experimental evidenceforclinical application. Methods:Forty-four patients diagnosed as AAD by computed tomography angiography(CTA) in cardiovascular surgery of the second affiliated hospital of zhengzhouuniversity from August2011to July2013. At the same time, forty patients diagnosedas acute coronary syndrome (ACS). In our study, the diagnosis mainly relies onelectrocardiogram,24h dynamic electrocardiogram, myocardial enzymes andcoronary angiography. Both the observation group and control group patientsD-dimmer levels in blood plasma were detected and statistically analyzed.Results:The level of D-dimmer in observation group all higher than normal limit. Andthe control group patients about D-dimer concentration fluctuations in normal. Theconcentration of plasma D-dimer in AAD group was significantly higher than that inACS group (for D-dimer, AAD: ACS,1.51mg/L±0.85mg/L vs0.41mg/L±0.13mg/L, P<0.05). The difference is statistically significant; The D-dimmer levels ofpatients with DeBakey Ⅰ AAD were significantly higher than those with DeBakeyⅡand Ⅲ(P<0.05). The difference is statistically significant; the plasma D-dimerlevel between DeBakey Ⅱ and DeBakeyⅢ patients no obvious difference (P>0.05).So there was no statistically significant difference; The D-dimmer levels weresignificantly higher in patients who died than that in those who survived (for D-dimer,the died: the survived,2.20mg/L±0.89mg/L vs1.40mg/L±0.80mg/L, P<0.05), thedifference is statistically significant.Conclusion:1．D-dimer can serve as early screening indicators for suspected patients withAAD, which has positive predictive value and negative rule out effect.2．The level of D-dimer for AAD preliminary classification has a certainmeaning. The concentration of plasma D-dimer in patients with DeBakey Ⅰ AADwere significantly higher than those with DeBakeyⅡand Ⅲ.3．The D-dimer level detection can be used as a biological index to distinguishAAD and ACS.4．The concentration of plasma D-dimer has an important guiding significancefor prognosis of AAD patients. The higher of the D-dimer in AAD patients, the more mortality during hospitalization.