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

• Yoshimuta Tsuyoshi

  Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science

• Yokoyama Hiroyuki

  Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Okajima Toshiya

  Division of Cardiology, Takarazuka City Hospital

• Tanaka Hiroshi

  Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center

• Toyoda Kazunori

  Department of Stroke, National Cerebral and Cardiovascular Center

• Nagatsuka Kazuyuki

  Department of Stroke, National Cerebral and Cardiovascular Center

• Higashi Masahiro

  Department of Radiology, National Cerebral and Cardiovascular Center

• Hayashi Kenshi

  Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science

• Kawashiri Masa-aki

  Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science

• Yasuda Satoshi

  Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center

• Yamagishi Masakazu

  Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Science

抄録

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)

収録刊行物

• Circulation Journal

  Circulation Journal 79 (8), 1841-1845, 2015

  一般社団法人 日本循環器学会

キーワード

• Acute aortic dissection
• D-Dimer
• Stroke

詳細情報

• CRID: 1390001205107208448
• NII論文ID: 120006338369
• NII論文ID: 130005089371
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-15-0050
• DOI: 10.24517/00014369
• ISSN: 13474820
• ISSN: 13469843
• NDL書誌ID: 026602739
• PubMed: 25993997
• Web Site: http://hdl.handle.net/2297/48526
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I026602739
• Web Site: https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-15-0050/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2016110729
• 本文言語コード: en
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