Impact of elevated d-dimer on diagnosis of acute aortic dissection with isolated neurological symptoms in ischemic stroke

Tsuyoshi Yoshimuta, Hiroyuki Yokoyama, Toshiya Okajima, Hiroshi Tanaka, Kazunori Toyoda, Kazuyuki Nagatsuka, Masahiro Higashi, Kenshi Hayashi, Masa Aki Kawashiri, Satoshi Yasuda, Masakazu Yamagishi

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Plasma d-dimer is known to be a useful clinical marker of thrombogenic status, and d-dimer is used as a diagnostic marker for acute aortic dissection (AAD). Little is known, however, regarding the clinical value of d-dimer for diagnosis of asymptomatic AAD in patients with ischemic stroke. We investigated whether d-dimer could be used for early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients. Methods and Results: We evaluated a total of 1,236 consecutive patients with symptomatic ischemic stroke without chest or back pain who underwent either head computed tomography or magnetic resonance imaging. d-Dimer was measured within 24 h after onset. There were 9 patients with Stanford type A AAD and they had significantly higher d-dimer than the patients without AAD (mean, 46.47 ±54.48 μg/ml; range, 6.9–167.1 μg/ml vs. 2.33±3.58 μg/ml, 0.3–57.9 μg/ml, P<0.001). When a cut-off of 6.9 μg/ml was adopted for d-dimer on the basis of receiver operating characteristics analysis, the sensitivity and specificity for AAD were 100% and 94.8%, respectively, while the positive and negative predictive values were 14.7% and 100%, respectively. Conclusions: d-Dimer might be a useful marker for the early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients. Whole-body contrast-enhanced computed tomography should be performed in ischemic stroke patients who have high d-dimer.

Original languageEnglish
Pages (from-to)1841-1845
Number of pages5
JournalCirculation Journal
Volume79
Issue number8
DOIs
Publication statusPublished - 2015 Jul 24
Externally publishedYes

Keywords

  • Acute aortic dissection
  • D-Dimer
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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