New biochemical markers of aortic dissection

The incidence of aortic dissection (AD) ranges from 5 to 30 cases per million people per year. Although the disease is uncommon, its outcome is frequently rapidly fatal. Consequently, the challenge in management of acute AD lies in early diagnosis and timely therapy. Unfortunately, clinical presentation is often misleading: physical findings may be absent or, if present, could be suggestive of other conditions, and therefore the correct diagnosis is missed in up to 40% of patients on initial clinical evaluation. Different diagnostic modalities are now available to improve aortic dissection detection. Spiral CT scanning, MRI and transoesophageal echocardiography are accurate modalities to detect AD with different sensitivity and specificity, but each of these techniques has potential limitations in the evaluation of different clinical-morphological presentation of the disease. Routine laboratory tests have been marginally used so far for AD diagnosis, mostly for differential diagnosis (i.e. myocardial specific enzymes for the exclusion of acute myocardial infarction). Recently, several serum biochemical markers for AD diagnosis and follow-up have been proposed; they may be very useful in association with established imaging tools to improve rapid diagnosis and, consequently, outcome. In this review, we will illustrate the most recent proposed biomarkers, their clinical usefulness and future implications for their utilisation.