Journal Article Impact of Elevated D-Dimer on Diagnosis of Acute Aortic Dissection With Isolated Neurological Symptoms in Ischemic Stroke.

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

79 ( 8 )  , pp.1841 - 1845 , 2015-07-24 , Japanese Circulation Society = 日本循環器学会
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. (Circ J 2015; 79: 1841–1845)

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