Potential Biomarkers For Early Diagnosis Of Acute Aortic Dissection

Objective:Acute aortic dissection (AAD) is an acute vascular lesion with high misdiagnosis and mortality rate. The early diagnosis is considered to be a big challenge for emergency department physicians all over the world. Therefore, we explore the biological markers for effective diagnosis of AAD.Methods:This is a prospective clinical study in a single center, study time frame is2012,12-2013,11. Following the inclusion and exclusion criteria strictly, we enrolled all patients with acute chest pain in6h in the emergency department from the Second Xiangya Hospital of Central South University, and accepted health people as the control at the same time. The general information and blood samples were collected and cryopreserved. All patients were diagnosed by aortic CTA or coronary angiography, and were divided into AAD group(patients with AAD), AMI group(patients with AMI), other chest pain group(chest pain patients without AAD or AMI) and the control group(health people). ELISA kit was used to detect plasma a-SMA, smMHC, sELAF, PCI and D-dimer. Statistical analysis, ROC curve analysis and Pearson correlation analysis were performed to evaluate the value of single and combined diagnosis.Results:Of the86subjects enrolled in this study,35cases were in AAD group (type A19cases and type B16cases),22cases in AMI group,19cases in the other chest pain group and10cases in the control group.1. Logistic regression analysis showed that arm blood pressure asymmetry, history of hypertension, Neu%, heart rate and systolic blood pressure were independent risk factors of AAD, and OR values were1.83,1.54,1.41,1.19and1.08respectively.2. a-SMA, smMHC, sELAF, PC1and D-dimer were compared between the four groups, AAD group was significantly higher than the other three groups, P<0.05.3. ROC curve analysis showed that the area under the curve from large to small was as D-dimer:0.93, PCI:0.90, sELAF:0.82, smMHC:0.81and a-SMA:0.62. The ROC curve of a-SMA had no significant difference, P>0.05, when the others had, P=0.00.4. The best diagnostic threshold and the corresponding diagnosis value:D-dimer (2.1lug/ml, sensitivity and specificity was80%and90.21%),PC1(357.33pg/ml, sensitivity and specificity was85.71%and75.61%), smMHC (2.1lng/ml, sensitivity and specificity was68.57%and90.24%), sELAF (97.07ng/ml, sensitivity and specificity was82.86% and68.29%), and a-SMA (49.62ng/ml, sensitivity and specificity was54.29%and90.24%).5. There were strong correlations between smMHC, sELAF, PC1and D-dimer which had significant diagnostic values of AAD. The ROC curve analysis of the combined diagnosis showed that the area under the curve was0.95, two positive biomarkers among the four biomarkers showed a good sensitivity (94.29%) and specificity (85.37%).Conclusion:1. smMHC, sELAF, PC1and D-dimer has an important value in the early diagnosis of AAD respectively.2. There has an increased diagnostic value when combined together smMHC, sELAF, PC1and D-dimer. They can be used as biomarkers for early diagnosis of AAD.