An emergency blood test for aortic dissection

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The aorta is the main artery in the body and carries blood from the heart to the rest of the body. Aortic dissection is a rare but life-threatening condition where there is a tear in the inner wall of the aorta. It is often fatal with a survival rate of less than 50%, and more people die in the UK of aortic dissections every year than in road accidents. It is thought that the low survival rate is often due to missed or delayed diagnosis when people arrive at hospital. Dissection is usually caused by an underlying aortic aneurysm – a weakness and bulging in the wall of the blood vessel. There are multiple causes of aneurysms, from genetic conditions such as Marfan syndrome, to other factors such as high blood pressure or smoking. However, aneurysms often have no symptoms up to the point of dissection. It is therefore important that we improve the diagnosis of acute aortic dissection, as well as improving how we measure the risk of dissection for those with a known aortic aneurysm.

Dr Choy and her team have a long running project that aims to do just that. Previous work has discovered a substance called desmosine that, when present in the blood, indicates damage to the aorta. Data shows that levels of desmosine in patients’ blood can accurately predict the severity of an aortic aneurysm and the risk of it dissecting. Excitingly, this has led to the possibility that desmosine can be used as a so called ‘biomarker’ for aortic dissection, in both existing aneurysms and acute dissections. Whilst this has important diagnostic potential, the process for measuring the level of desmosine in the blood takes too long for it to be useful in an emergency. Dr Choy’s current project aims to therefore shorten this analysis time so that desmosine may be used in emergency diagnostics. They will also look at whether this method can be used for risk assessment of dissection for existing aortic aneurysms.

If this process can be successfully shortened, it has the potential to change the game in the diagnosis of acute aortic dissection. Quicker diagnoses on arrival at hospital would be the turning point in improving survival and long-term outcomes for patients. The discovery of desmosine also has significant potential in informing us about the risk of dissection in aortic aneurysms, which would help patients to make informed decisions about their own care.