Lysophosphatidic Acid May Be a Novel Biomarker for Early Acute Aortic Dissection

Xiaogao Pan; Yang Zhou; Guifang Yang; Zhibiao He; Hongliang Zhang; Zhenyu Peng; Wen Peng; Tuo Guo; Mengping Zeng; Ning Ding; Xiangping Chai

doi:10.3389/fsurg.2021.789992

Lysophosphatidic Acid May Be a Novel Biomarker for Early Acute Aortic Dissection

Front Surg. 2022 Jan 10:8:789992. doi: 10.3389/fsurg.2021.789992. eCollection 2021.

Authors

Xiaogao Pan^{1

2}, Yang Zhou^{1

2}, Guifang Yang^{1

2}, Zhibiao He^{1

2}, Hongliang Zhang^{1

2}, Zhenyu Peng^{1

2}, Wen Peng^{1

2}, Tuo Guo^{1

2}, Mengping Zeng^{1

2}, Ning Ding³, Xiangping Chai^{1

2}

Affiliations

¹ Department of Emergency Medicine, Second Xiangya Hospital, Central South University, Changsha, China.
² Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, Changsha, China.
³ Emergency Department, Changsha Central Hospital, University of South China, Changsha, China.

Abstract

Background: Misdiagnosis and delayed diagnosis of acute aortic dissection (AAD) significantly increase mortality. Lysophosphatidic acid (LPA) is a biomarker related to coagulation cascade and cardiovascular-injury. The extent of LPA elevation in AAD and whether it can discriminate sudden-onset of acute chest pain are currently unclear. Methods: We measured the plasma concentration of LPA in a cohort of 174 patients with suspected AAD chest pain and 30 healthy participants. Measures to discriminate AAD from other acute-onset thoracalgia were compared and calculated. Results: LPA was significantly higher in AAD than in the AMI, PE, and the healthy (344.69 ± 59.99 vs. 286.79 ± 43.01 vs. 286.61 ± 43.32 vs. 96.08 ± 11.93, P < 0.01) within 48 h of symptom onset. LPA level peaked at 12 h after symptom onset, then gradually decreased from 12 to 48 h in AAD. LPA had an AUC of 0.85 (0.80-0.90), diagnosis threshold of 298.98 mg/dl, a sensitivity of 0.81, specificity of 0.77, and the negative predictive value of 0.85. The ROC curve of LPA is better than D-dimer (P = 0.041, Delong test). The decision curve showed that LPA had excellent standardized net benefits. Conclusion: LPA showed superior overall diagnostic performance to D-dimer in early AAD diagnosis may be a potential biomarker, but additional studies are needed to determine the rapid and cost-effective diagnostic tests in the emergency department.

Keywords: aortic dissection; biomarker; chest pain; diagnosis; lysophosphatidic acid.