The aim of the present was to assess the value of the ELISA D-dimer (hemostatic marker) assay in patients with coronary artery disease as well as ischemic heart disease presenting to the emergency department with chest pain syndrome. Methods: We measured levels of D-dimers (Âµg/ml by immunoturbidimetric assay) in 120 patients with angiographically proved CAD, consecutive outpatients with chest pain, arterial fibrillation, acute coronary syndromes and 240 age and sex matched healthy controls. Demographic characteristics were assessed by a standardized questionnaire, and a complete lipid profile was performed for all subjects. In addition to this inflammatory marker C- reactive protein was also measured. Result: The distribution of D-dimer levels skewed to the right, and plasma mean levels were higher in cases than in control (mean: 2.51Â±3.60 vs .41Â±.59 Âµg/ml; p<0.001). In contrast, correlation of D-dimer was found with C-reactive protein (p<0.001) and is higher in cases than controls. Conclusion: Plasma D-dimer levels are strongly and independently associated with the presence of CAD in patients with stable angina. These results support the concept of a contribution of intravascular fibrin to atherothrombogenesis

Ajay K. Singh , Vikas Gupta, Neelima Singh, Sanjeev K. Singh , Nivedita Singh, Arun Raiza, Harshverdhan Singh , Int J Cur Biomed Phar Res.

English

Cognitive Sciences ePrint Archive

Role of Immunoturbidimetric plasma fibrin D-dimer test in patients with coronary
artery disease as well as ischemic heart disease in emergency medicine
a a a a
Ajay K. Singh *, Vikas Gupta , Neelima Singh , Sanjeev K. Singha , Nivedita Singh ,
b b
Arun Raiza , Harshverdhan Singh ,
A R T I C L E I N F O A B S T R A C T
Keywords:
Original article 
D-dimer 
Coronary artery disease
 Immunoturbidimetric method 
C-reactive protein
Lipid profile
1. Introduction
The aim of the present was to assess the value of the ELISA D-dimer (hemostatic marker) assay 
in patients with coronary artery disease as well as ischemic heart disease presenting to the 
emergency department with chest pain syndrome. Methods: We measured levels of D-dimers 
(Âµg/ml by immunoturbidimetric assay) in 120 patients with angiographically proved CAD, 
consecutive outpatients with chest pain, arterial fibrillation, acute coronary syndromes and 
240 age and sex matched healthy controls. Demographic characteristics were assessed by a 
standardized questionnaire, and a complete lipid profile was performed for all subjects. In 
addition to this inflammatory marker C- reactive protein was also measured. Result: The 
distribution of D-dimer levels skewed to the right, and plasma mean levels were higher in cases 
than in control (mean: 2.51Â±3.60 vs .41Â±.59 Âµg/ml; p<0.001). In contrast, correlation of D-
dimer was found with C-reactive protein (p<0.001) and is higher in cases than controls. 
Conclusion: Plasma D-dimer levels are strongly and independently associated with the 
presence of CAD in patients with stable angina. These results support the concept of a 
contribution of intravascular fibrin to atherothrombogenesis.
Cardiovascular disease (CVD) is the leading cause of death and 
disability in developed nations and is increasing rapidly in the 
developing world, it is estimated that CVD will surpass infectious 
disease as the World's leading cause of death and disability [1]. 
Acute coronary syndromes occur when an unstable plaque 
ruptures and activates coagulation at the site, blocking blood flow 
and causing ischemic injury to the heart. Thrombogenesis is the 
final process whereby the exposed tissue factor triggers the 
activation of coagulation and the freshly formed clot fills the 
coronary artery lumen [2]. Several studies suggest that the 
likehood myocardial infarction is higher in patient having high 
levels of biochemical markers of thrombus formation such as 
fibrinogen, prothrombin fragment [3, 4], thrombin-antithrombin 
complex and fibrinopeptides [5]. It is widely accepted that 
thrombosis, provoked by a rupture of an atherosclerotic plaque, 
play key role in triggering a coronary heart disease event [6].
D-dimer is the primary degradation product of cross-linked 
fibrin and therefore serves as a direct marker of ongoing 
coagulation with fibrinolysis [7]. D-dimer level increases in 
patients with unstable angina pectoris (UPA) and acute myocardial 
infarction [8], and is an early marker of coronary ischemia in 
patients with chest pain [9].  
Patients and control were recruited between June 2008 t0 July 
2009. Consecutive outpatients with chest pain, arterial fibrillation, 
acute coronary syndromes etc. admitted in the emergency 
department of Escort Heart Institute and Research Centre, New 
Delhi. Exclusion criteria were age under 18 years, use of 
2.Materials and Methods:
Copyright 2011. CurrentSciDirect Publications.  IJCBPR - All rights reserved.c
Contents lists available at CurrentSciDirect Publications
Journal homepage: www.currentscidirect.com
International Journal of Current Biomedical and Pharmaceutical Research 
Int J Cur Biomed Phar Res. 2011; 1(2): 31 – 33.
CurrentSciDirect
Publication
a
*Department of 1Biochemistry, Gajra Raja Medical College, Gwalior, M.P., India.
b
Department of 2Biochemistry, Escort Heart Institute and Research Centre, New Delhi, India.
*  Corresponding Author : Ajay Kumar Singh
Research Scholar (Biochemist)
Department Of Biochemistry, G.R. Medical College, Gwalior
(M.P.) India-474001
Email : ajsingh25@gmail.com
Copyright 2011. CurrentSciDirect Publications.  - All rights reserved. IJCBPRc
anticoagulation agents, presence of primary coagulopathy or 
nephritic syndrome, recent surgery, infection in the month 
proceeding the study, abnormal renal function test or liver and 
deep vein thrombosis in the last year. The healthy controls were 
selected from hospital staff without any history of diabetes 
mellitus, HTN and coronary heart disease. Informed consent was 
provided to all patients for D-dimer assay.
Fasting venous blood samples were drawn in the morning after 
overnight fasting under standardized condition from patients 
admitted in ED. Four ml of blood were collected, out of which 2 ml 
transfer to the gel vaccutainer for estimation of other parameters 
(CRP, FBS, lipid profile and cardiac enzyme) and 2 ml blood mixed 
with 0.2 ml buffered sodium citrate and centrifuged at 3,000 rpm 
for 10 minutes within 30 minutes for plasma.  Plasma fibrin D-
dimer levels were evaluated by Latex turbidometric assay (Hitachi 
917, Roche Diagnostics, Japan) according to manufacturer 
instructions.
The SPSS 16.0 software (Chicago, IL, USA) was used for 
statistical analysis. Differences in various parameters between the 
two groups were analyzed for significance using the student's t-
test. Statistical significance was defined as P<0.01
The study included 120 consecutive patients (both male and 
female) mean age 56±13.52 years had a positive clinical sign of 
coronary heart disease as well as ischemic heart disease. The 
characteristics of patients and controls are listed in Table 1. D-
dimer and hs-CRP levels was significantly higher (P>0.001) in CHD 
patients as compared to control subjects. Other biochemical 
parameters like fasting blood sugar and lipid profile (TG, HDL-C 
and LDL-C) were also changed significantly (P>0.001) in CHD 
patients as compared to control subjects.     
For a long time progression of coronary artery disease leading 
to acute coronary syndrome was believed due to continuous 
progression of coronary atherosclerosis. Rapid progression of 
coronary atherosclerosis leading to complex coronary syndromes 
often is due to the plaque disruption. Plaques that are prone to 
disruption are characterized by a thin, fibrous cap with a reduced 
collagen content covering a large lipid pool. Acute coronary 
syndrome will occurs when thrombus formation lead to a severe 
reduction of coronary blood flow [10]. D-dimer is the breakdown 
product formed when plasmin act on cross linked fibrin therefore 
it can be considered as a marker of fibrin production and plasmin 
activity [11]. Originally, von Rokistansly and later Duguid 
proposed that intima thickening at initial atherosclerosis results 
from mural thrombosis and fibrinolytic organization [12, 13]. 
Some other studies have supported this hypothesis [11]. The 
experimental finding showed elevated level of study parameters 
in patients as compared to the control subjects. This finding is 
consistent with the results of Lowe GDO et al, that shows the 
defective fibrinolysis may play a role in early progression of 
atherosclerotic lesions in additions to the clinical CHD events 
(UAP, Acute shock, MI) [14].
D-dimer is the primary degradation product of cross linked 
fibrin and therefore it can be regarded as a global marker of the 
turnover of crosslinked fibrin and of activation of the hemostatic 
system. A D-dimer level seems to be independent of other 
cardiovascular risk factors, which suggests that they might add 
relevant information in addition to lipid variables and other 
classical risk factors. In contrast to several other marker of 
hemostasis, D-dimer assays are more suitable and more practical 
to measure and therefore, may be more suitable from a diagnostic 
point of view for physicians in emergency department, when 
patients comes with chest pain. 
We are indebted to the participants in the study and their 
cooperation.
Conflicts of interest: 
The authors had no conflicts of interest to declare in relation to 
this article.
3.Results
4.Discussion
5.Conclusion
Acknowledgments:
Ajay K. Singh et al. / Int J Cur Biomed Phar Res. 2011; 1(2): 31 – 33.
In our study higher concentration of D-dimer, hs-CRP, Lipid profile 
levels was found in patients with coronary heart disease as 
compared to controls (Shows in Table 1). In CHD as well as 
atherosclerosis, the plaque formation in the vessel is increased. 
The disruption of the plaque formed result in increase of 
coagulation along with fibrinolysis. Its fits well with the concept of 
hypercoagulable state that has been found hypothesized to 
proceed clinical CHD events (MI, UAP, ACS) [15]. Thus showing 
high turnover of fibrin in these individuals.
This is consistent with the study of Shitrit D et al, [16]. Tataru M-
C et al, also reported that there is a high turnover of D-dimer level 
in ischemic heart diseases [17]. Higher levels of D-dimer were 
noted in peripheral blood of patients with UAP. In addition to this, 
in one study there was an approximately 5 fold increases in 
patients with UAP and acute MI [5]. It may reflect systematic 
prothrombic state and possibly, focal vessel wall related to fibrin 
formation (D-dimer) with unstable atherosclerotic plaque activity 
[18]. D-dimer level in affected patients in the time of admission to 
emergency department, add information about the magnitude of 
UAP even with normal ECG, this happen so because the time 
between the appearance of symptom and admission to emergency 
department is long enough to normalize the ECG but the higher 
level of D-dimer remains unchanged and can be analyzed [16].
In arterial fibrillation higher D-dimer levels are found because 
of thromboembolism. The D-dimer level predicts prthrombotic 
states suggested by preliminary associations with venous 
thrombosis and other conditions associated with embolism [19] 
and intracardiac thrombosis and the rapid normalization of D-
dimer values after cardioversion [20] or warfarinization [21] in 
the patients with arterial fibrillation. This study is supported by 
Ariel Cohen et al, [22].  The diagnostic value of hemostatic marker 
in patients presenting to the ED with chest pain syndrome, Shitrit 
D et al, found that D-dimer levels were significantly higher in 
patients with acute MI and UAP than in non ischemic patients and 
significant changes were observed in fasting blood sugar 
(p<0.001), lipid profile (p<0.001), D-dimer (p<0.001), as 
compared to control groups [16].
2.1.Sample collection and D-Dimer assays:
32
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Ajay K. Singh et al. / Int J Cur Biomed Phar Res. 2011; 1(2): 31 – 33.
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Role of immunoturbidimetric plasma fibrin D-dimer test in patients with coronary artery disease as well as ischemic heart disease in emergency medicine

Role of immunoturbidimetric plasma fibrin D-dimer test in patients with coronary artery disease as well as ischemic heart disease in emergency medicine

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