What are diagnostic implications and limitations of assessing D-dimer and fibrin degradation products levels in the management of patients with acute aortic dissection?

Acute aortic dissection (AAD) is an uncommon but potentially catastrophic condition, with an early mortality rate as high as 1% per hour. Acute myocardial infarction (AMI) is also a serious cardiovascular disease with high mortality, albeit much lower than in AAD. One of the reasons for the lower mortality in AMI than AAD is that the former can be diagnosed with high specificity using biomarkers such as Troponin T or Troponin I. In contrast, AAD can only be diagnosed by MRI or CT imaging, as there are no unequivocal diagnostic biomarkers available. Certain biomarkers have been proposed for this purpose, such as myosin-heavy chain (1), creatinine phosphokinase-BB (2), calponin (3), TGF-beta (4) or serum elastin (5), but they have too low a specificity to be clinically useful in practice.