Aortic dissection laboratory findings: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Template:Aortic dissection}} | {{Template:Aortic dissection}} | ||
{{CMG}}; '''Associate Editor-In-Chief:''' {{Sahar}} {{CZ}} | {{CMG}}; '''Associate Editor-In-Chief:''' {{Sahar}} {{CZ}} {{Laith}} | ||
==Overview== | ==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 [[diagnosis|diagnose]] [[aortic]] dissection. | 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 [[diagnosis|diagnose]] [[aortic]] dissection. | ||
==Laboratory Findings== | ==Laboratory Findings== | ||
There is no particular laboratory findings for the diagnosis of aortic dissection. Possible laboratory findings associated with aortic dissection may include: | There is no particular laboratory findings for the [[diagnosis]] of aortic dissection. Possible laboratory findings associated with aortic dissection may include: | ||
*D-dimer elevation | *[[D-dimer]] elevation | ||
*Troponin elevation | *[[Troponin]] elevation | ||
*CK-MB elevation | *[[CK-MB]] elevation | ||
*Hematuria | *[[Hematuria]] | ||
===D-dimer=== | ===D-dimer=== | ||
*Aortic dissection is more likely in the case of elevated D-dimer levels. It | *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.<ref name="RogersHermann2011">{{cite journal|last1=Rogers|first1=Adam M.|last2=Hermann|first2=Luke K.|last3=Booher|first3=Anna M.|last4=Nienaber|first4=Christoph A.|last5=Williams|first5=David M.|last6=Kazerooni|first6=Ella A.|last7=Froehlich|first7=James B.|last8=O'Gara|first8=Patrick T.|last9=Montgomery|first9=Daniel G.|last10=Cooper|first10=Jeanna V.|last11=Harris|first11=Kevin M.|last12=Hutchison|first12=Stuart|last13=Evangelista|first13=Arturo|last14=Isselbacher|first14=Eric M.|last15=Eagle|first15=Kim A.|title=Sensitivity of the Aortic Dissection Detection Risk Score, a Novel Guideline-Based Tool for Identification of Acute Aortic Dissection at Initial Presentation|journal=Circulation|volume=123|issue=20|year=2011|pages=2213–2218|issn=0009-7322|doi=10.1161/CIRCULATIONAHA.110.988568}}</ref> | ||
===Cardiac Biomarkers=== | ===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.<ref name="BONNEFOYGODON2005">{{cite journal|last1=BONNEFOY|first1=Eric|last2=GODON|first2=Patrick|last3=KIKORIAN|first3=Gilbert|last4=CHABAUD|first4=Sylvie|last5=TOUBOUL|first5=Paul|title=Significance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta|journal=Acta Cardiologica|volume=60|issue=2|year=2005|pages=165–170|issn=0001-5385|doi=10.2143/AC.60.2.2005027}}</ref> | *[[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]].<ref name="BONNEFOYGODON2005">{{cite journal|last1=BONNEFOY|first1=Eric|last2=GODON|first2=Patrick|last3=KIKORIAN|first3=Gilbert|last4=CHABAUD|first4=Sylvie|last5=TOUBOUL|first5=Paul|title=Significance of serum troponin I elevation in patients with acute aortic dissection of the ascending aorta|journal=Acta Cardiologica|volume=60|issue=2|year=2005|pages=165–170|issn=0001-5385|doi=10.2143/AC.60.2.2005027}}</ref> | ||
*The presence of an elevated [[CK MB]] may indicate the presence of concurrent [[acute myocardial infarction]].<ref name="Davidson1988">{{cite journal|last1=Davidson|first1=E.|title=Elevated serum creatine kinase levels. An early diagnostic sign of acute dissection of the aorta|journal=Archives of Internal Medicine|volume=148|issue=10|year=1988|pages=2184–2186|issn=00039926|doi=10.1001/archinte.148.10.2184}}</ref> | *The presence of an elevated [[CK MB]] may indicate the presence of concurrent [[acute myocardial infarction]].<ref name="Davidson1988">{{cite journal|last1=Davidson|first1=E.|title=Elevated serum creatine kinase levels. An early diagnostic sign of acute dissection of the aorta|journal=Archives of Internal Medicine|volume=148|issue=10|year=1988|pages=2184–2186|issn=00039926|doi=10.1001/archinte.148.10.2184}}</ref> | ||
===Biomarker Studies=== | ===Biomarker Studies=== | ||
| Line 20: | Line 21: | ||
*[[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)<ref>{{cite journal|title=2014 ESC Guidelines on the diagnosis and treatment of aortic diseases|journal= | == 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<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"|<nowiki>"</nowiki>In case of suspicion of AAS, the interpretation of biomarkers should always be considered along with the pretest clinical probability.''([[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: | | colspan="1" style="text-align:center; background:LemonChiffon"|[[ESC guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor=" | |bgcolor="LemonChiffon"|"In case of low clinical probability of AAS, negative Ddimer levels should be considered as ruling out the diagnosis. (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" | {|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"|"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)"<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:Lightcoral"|[[ESC guidelines classification scheme#Classification of Recommendations|Class III]] | ||
|- | |- | ||
|bgcolor=" | |bgcolor="Lightcoral"|"In patients with high probability (risk score 2 or 3) of AD, testing of D-dimers is not recommended. (Level of Evidence:C)" | ||
|} | |||
== References == | == References == | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 02:55, 4 December 2022
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Aortic dissection Microchapters |
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Diagnosis |
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Treatment |
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Special Scenarios |
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Case Studies |
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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
- 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 |
| "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
- ↑ 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.