D-dimer measurement is a useful tool of acute aortic syndrome

We read with great interest the article by Otani et al [ ] for sharing their study “ D-dimer measurement is useful irrespective of time from the onset of acute aortic syndrome symptoms”. D-dimer levels were elevated from the early stages of acute aortic syndrome (AAS). And the clinical utility remained consistent regardless of the time interval from AAS onset. In our tertiary medical center in northern Taiwan, we conducted a comprehensive assessment of D-dimer levels in numerous patients presenting with chest pain at the emergency department. This evaluation included AAS cases in clinical settings such as intramural hematoma, where we also observed elevated D-dimer levels. Sometimes, the patient with AAS may have vague symptoms such as anxiety, dizziness, palpitation, shoulder pain, partial limb numbness and diaphoresis.

Furthermore, Nazerian et al. [ ] suggested the integration of Aortic Dissection Detection Risk Score with D-Dimer as a potential approach to standardize the diagnostic rule-out process for AAS. Their findings showed that a positive DD test (≥500 ng/mL) had a sensitivity of 96.7% for diagnosing AAS. This highlights the importance of maintaining a high index of suspicion among emergency physicians when evaluating patients with suspected AAS.

Some emergent physicians may also encounter cases of AAD with concurrent ST-segment elevation myocardial infarction (STEMI), which is a relatively rare but potentially fatal condition. While ultrasound can be useful in differentiating these conditions to some extent., a point-of-care D-dimer survey with a new cutoff value could be a valuable tool in ruling out AAD among patients with STEMI [ ]. Specifically, applying a D-dimer cutoff value of ≥750 ng/mL resulted in a sensitivity, specificity, PPV, and NPV of 100%, 86.4%, 37.7%, and 100%, respectively.

Additionally, we found higher D-Dimer level in patients of covid-19 infection who were admitted to the intensive care unit in our hospital [ , ]. Our Emergency Medical Services system [ ] transported a significant number of COVID-19-infected patients.

In conclusion, we emphasize the need for emergency physicians to maintain a high level of suspicion when evaluating patients, especially the elderly, who may present with atypical symptoms suggestive of AAS. D-dimer measurements can significantly contribute to achieving a more precise diagnosis in such cases. We express our gratitude to Dr. Otani and colleagues for their valuable contributions to our understanding of these critical medical conditions.

CRediT authorship contribution statement

Ting-Li Tai: Writing – original draft. Chia-Yin Hsieh: Software, Visualization. Fu-Shan Jaw: Conceptualization. Tang-Sai Tat: Supervision, Validation. Chien-Chieh Hsieh: Conceptualization, Data curation, Project administration, Writing – review & editing.