Novel Blood Biomarkers for a Diagnostic Workup of Acute Aortic Dissection

Abstract

Acute aortic dissection (AAD) is a rare condition, but together with acute myocardial infarction (AMI) and pulmonary embolism (PE) it belongs to the most relevant and life-threatening causes of acute chest pain. Until now, there has been no specific blood test in the diagnostic workup of AAD. To identify clinically relevant biomarkers for AAD, we applied Proseek^® Multiplex assays to plasma samples from patients with AAD, AMI, PE, thoracic aortic aneurysm (TAA), and non-cardiovascular chest pain (nonCVD). Subsequently, we validated top hits using conventional immunoassays and examined their expression in the aortic tissue. Interleukin 10 (IL-10) alone showed the best performance with a sensitivity of 55% and a specificity of 98% for AAD diagnosis. The combination of D-dimers, high-sensitive troponin T (hs-TnT), interleukin 6 (IL-6), and plasminogen activator inhibitor 1 (PAI1) correctly classified 75% of AAD cases, delivering a sensitivity of 83% and specificity of 95% for its diagnosis. Moreover, this model provided the correct classification of 77% of all analyzed cases. Our data suggest that IL-10 shows potential to be a rule-in biomarker for AAD. Moreover, the addition of PAI1 and IL-6 to hs-TnT and D-dimers may improve the discrimination of suspected AAD, AMI, and PE in patients presenting with acute chest pain.

Keywords: D-dimers; IL-10; acute aortic dissection; acute myocardial infarction; biomarker; pulmonary embolism.

Figure 1

Plasma concentrations of IL-1ra (panel A), IL-10 (panel B), IL-6 (panel C), IGFBP1 (panel D), PAI1 (panel E), D-dimers (panel F), and hs-TnT (panel G) in the confirmatory cohort. * p-value < 0.05; ** p-value < 0.01, *** p-value < 0.001.

Figure 2

Immunohistochemical staining of IL-6, IL-10, PAI1, IL-1ra, and IGFBP1 in the aortic tissue of patients with AAD, TAA, and AVR.