Elevated plasma D-dimer and hypersensitive C-reactive protein levels may indicate aortic disorders

Objective: D-dimer and C-reactive protein are of diagnostic and predictive values in patients have thrombotic tendency, such as vascular thrombosis, coronary artery disease and aortic dissection. However, the comparative study in these biomarkers between the patients with acute aortic dissection and coronary artery disease has not been sufficiently elucidated. Methods: Consecutive surgical patients for acute type A aortic dissection (20 patients), aortic aneurysm (nine patients) or coronary artery disease (20 patients) were selected into this study. Plasma from preoperative blood samples and supernatant of aortic homogenate of the surgical specimens were detected for D-dimer and hypersensitive C-reactive protein (hs-CRP). Results: Plasma D-dimer and hs-CRP values in type A aortic dissection or aortic aneurysm were much higher than in coronary artery disease patients or the healthy control (for D-dimer, aortic dissection: coronary artery disease, 0.4344 +/- 0.2958 mu g/ml vs. 0.0512 +/- 0.0845 mu g/ml, P < 0.0001; aortic dissection: healthy control, 0.4344 +/- 0.2958 mu g/ml vs. 0.1250 +/- 0.1295 mu g/ml, P = 0.0005; aortic aneurysm: coronary artery disease, 0.4200 +/- 0.4039 mu g/ml vs. 0.0512 +/- 0.0845 mu g/ml, P = 0.0013; and aortic aneurysm: healthy control, 0.4200 +/- 0.4039 mu g/ml vs. 0.1250 +/- 0.1295 mu g/ml, P = 0.0068; and for hs-CRP, aortic dissection: coronary artery disease, 4.400 +/- 3.004 mg/L vs. 1.232 +/- 0.601 mg/L, P < 0.0001; aortic dissection: healthy control, 4.400 +/- 3.004 mg/L vs. 0.790 +/- 0.423 mg/L, P < 0.0001; aortic aneurysm: coronary artery disease, 2.314 +/- 1.399 mg/L vs. 1.232 +/- 0.601 mg/L, P = 0.0084; aortic aneurysm: healthy control, 2.314 +/- 1.399 mg/L vs. 0.790 +/- 0.423 mg/L, P = 0.0002; and coronary artery disease: healthy control, 1.232 +/- 0.601 mg/L vs. 0.790 +/- 0.423 mg/L, P = 0.0113). Besides, there were close correlations between plasma D-dimer and hs-CRP in overall (Y = 4.8798X + 0.8138, r(2) = 0.4497, r = 0.671, P < 0.001), aortic dissection (Y = 2.6298X + 1.2098, r(2) = 0.5762, r = 0.759, P < 0.001), and aortic aneurysm (Y = 7.1341X + 1.3006, r(2) = 0.4935, r = 0.7025, P = 0.048) groups rather than in the coronary artery disease or healthy control subjects. In addition, there were no significant differences between D-dimer and hs-CRP values of the aortic supernatant among groups except for undetectable D-dimer in the aortic supernatant of the coronary artery disease group. Conclusions: The patients with acute aortic dissection and aortic aneurysm may reflect the extensive inflammatory reaction and severe coagulopathies in the patients with acute type A aortic dissection, and thoracic aortic aneurysm in comparison to the coronary patients and healthy control individuals. The detections after onset in the patients with acute chest pain may help making a differential diagnosis between the aortopathies and ischemic heart disease. The scanty significance of the tissue biomarkers may preclude their diagnostic value in clinical practice.