Abstract Background Acute aortic dissection (AAD) is a life-threatening condition characterised by tearing of the aortic wall, leading to significant morbidity and mortality. It requires immediate diagnosis and often needs emergency surgical treatment. Unfortunately, misdiagnosis rates of type A AAD is very common in the emergency department (ED), up to one third of cases according to our recent local study. Purpose We hypothesized that patients with AAD would exhibit elevated levels of aggrecan, D-dimer and desmosine, and that the combination of these biomarkers could enhance the diagnostic accuracy of AAD in the ED. This study aims to evaluate the diagnostic performance of these biomarkers in combination with the Aortic Dissection Detection Risk Score (ADD-RS) in identifying AAD. Methods This was a prospective single-centre observational study conducted at the ED of a tertiary level university teaching hospital dealing with 150,000 patients annually. We recruited 28 adult patients between May 2023 and September 2024 who presented to the ED within 24 hours of symptom onset and were confirmed to have AAD and were admitted to the Division of Cardiothoracic Surgery. We recruited 28 age and sex matched healthy controls for comparison. We collected clinical data and blood samples from all participants for analysis. We analyzed the biomarkers (aggrecan, D-dimer and desmosine) using commercial enzyme-linked immunosorbent assay (ELISA) kits and performed receiver operating characteristic analysis to evaluate these biomarkers, as well as their combination with the ADD-RS for detection of AAD. This study was approved by the institutional review board. All participants have provided written informed consent. Results The mean D-dimer (±SD) level was significantly higher in patients with AAD (3457±3745 ng/ml vs 1205±1733 ng/ml, p=0.005), while the mean aggrecan level was lower (2467±792 ng/ml vs 3130±889 ng/ml, p=0.005). The analysis revealed no statistically significant difference in desmosine between the two groups. The Area Under the Curve (AUC) of D-dimer, desmosine, aggrecan and their combination for diagnosis of AAD were 0.747 (95% CI: 0.613 to 0.854), 0.529 (95% CI: 0.391 to 0.664), 0.723 (95% CI: 0.587 to 0.834) and 0.809 (95% CI: 0.681 to 0.901) respectively. The combination of ADD-RS1 with D-dimer and aggrecan, and with all three biomarkers, further improved the AUC to 0.917 (95% CI: 0.812 to 0.974) and 0.923 (95% CI: 0.820 to 0.977) respectively. Conclusion This study was the first to investigate the combination of different biomarkers for the diagnosis of AAD. We demonstrated improved diagnostic accuracy for AAD with the combination of the ADD-RS and selected biomarkers. We will conduct larger-scale studies to validate this new diagnostic strategy.
Graham et al. (Sat,) studied this question.