Circadian Variation of Acute Aortic Dissection

Seguchi, Masaru; Wada, Hiroshi; Sakakura, Kenichi; Nakagawa, Tom; Ibe, Tatsuro; Ikeda, Nahoko; Sugawara, Yoshitaka; Ako, Junya; Momomura, Shin‐ichi

doi:10.1536/ihj.14-328

Cited by 10 publications

(5 citation statements)

References 31 publications

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“…In the current study, based on our multicenter data, we found that patients with a history of hypertension were more likely to have high SBPV, which was further associated with an increased incidence of AEs. These findings could be explained by the abnormal BP rhythm and poor BP control and were in line with the results of previous studies (17,19,33). There is a challenge, however, in estimating the average SBPV and classifying the patients into high and low SBPV groups given different target populations in clinical practice; additionally, when using only the SD of the SBP as a summary measure, there is a loss of information.…”

Section: The Review In the Context Of Other Literaturesupporting

confidence: 89%

“…Earlier studies indicated that the incidence of AD varied within a day in that the highest incidence occurred between 6:00 am and 12:00 am (31). The chronobiological patterns of AD onset were consistent with the circadian variation in BP ( 14), and patients who lack a nocturnal BP fall may have a higher risk of AD (17). These results indicated that the circadian rhythm of BP fluctuations had impacts on the occurrence of AD.…”

Section: The Review In the Context Of Other Literaturesupporting

confidence: 61%

“…Second, the fixed threshold fails to take into account the dynamic nature of BP, which is critical in the development of cardiovascular events. For instance, earlier studies have suggested that the circadian rhythm of BP fluctuation has an impact on the occurrence of AD (14)(15)(16)(17) and that BP variations have strong predictive power for adverse events (AEs) in AD (18,19). There is, however, no clear correlation between the pattern of change in BP and the prognosis for AD.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Impact of Blood Pressure Change Patterns on Patients With Aortic Dissection After Admission

Qiu

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesHypertension is a predominant risk factor for aortic dissection (AD), and blood pressure (BP) control plays a vital role in the management of AD. However, the correlation between BP change and the prognosis for AD remains unclear. This study aims to demonstrate the impact of BP change patterns on AD prognosis.MethodsThis retrospective study included AD patients at two institutions (Shanghai Ninth People's Hospital Affiliated with Shanghai Jiao Tong University School of Medicine and the Vascular Department of the First Affiliated Hospital of Anhui Medical University) between 2004 and 2018. The systolic BP (SBP) change patterns of these patients were analyzed by functional data analysis (FDA). The relationship between BP change patterns and the risk of adverse events (AEs) was assessed using survival analysis.ResultsA total of 458 patients with AD were eligible for analysis. The logistic regression analysis indicated that compared with that in patients with low SBP variation (SBPV), the incidence of AEs in patients with high SBPV was significantly higher (35.84 vs. 20.35%, OR 2.19, P < 0.001). The patients were divided into four categories (accelerating rise, accelerating drop, decelerating rise, and decelerating drop) based on their SBP patterns after FDA fitting. The results of Kaplan–Meier analysis showed that at the 15- and 20-min time points, the incidence of AEs in the decelerating-drop group was significantly lower than that in the accelerating-rise group (OR 0.19, P = 0.031 and OR 0.23, P = 0.050). However, at the 25- and 30-min time points, the difference between these four groups was not significant (OR 0.26, P = 0.08 and OR 0.29, P = 0.10).ConclusionsThis study classified AD patients into four groups according to the SBP change patterns the first 30 min following admission, of which those with accelerating rises in SBP are at the highest risk of AEs, while those with decelerating drops have the best prognosis in the first 24 h after admission. Clinical practitioners may benefit from analyzing patterns of in-hospital SBP.

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Section: The Review In the Context Of Other Literaturesupporting

confidence: 89%

Section: The Review In the Context Of Other Literaturesupporting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

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Prognostic Impact of Blood Pressure Change Patterns on Patients With Aortic Dissection After Admission

Qiu

et al. 2022

Front. Cardiovasc. Med.

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“…7) A previous study has identified some predictors of inhospital mortality in acute type B aortic dissection including age, abrupt onset of chest pain, hypertension, kidney failure, pulse deficit, abnormal electrocardiography (ECG) findings, and absence of a nocturnal blood pressure fall. [8][9][10] Since patients with AAD usually receive medical treatment during the acute phase, Kudo, et al 11) suggest that maximum aortic diameter of ≥ 40 mm or ulcer-like projections at onset are predictors of aortic events. Actually, there is growing evidence that multiple assessments of several biomarkers may provide complementary information about the risk of death in aortic dissection patients.…”

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confidence: 99%

Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

et al. 2016

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SummaryThis retrospective study aimed to investigate the predictive value of biomarkers for in-hospital mortality of patients with Stanford type A acute aortic dissection (AAD).AAD is a life-threatening disease with an incidence of about 2.6-3.6 cases per 100,000/year. A total of 67 consecutive Stanford type A AAD patients admitted to hospital were divided into a deceased group and survival group. The baseline information of the patients between two groups was systematically compared, followed by examination of the electrocardiograms (ECG). Based on the follow-up during hospitalization, we investigated the simultaneous assessment of indexes like fragmented QRS complex (fQRS), admission systolic blood pressure (SBP), aortic diameter, surgical management, troponin I (TnI), white blood cell (WBC) count, N-terminal pro-brain natriuretic peptide (NT-proBNP), and D-dimer.The levels of TnI and NT-proBNP, WBC counts, and rate of fQRS (+) in patients of the deceased group were significantly higher than those in the survival group. The male sex (hazard ratio, 10.88; P = 0.001), admission SBP (hazard ratio, 0.98; P = 0.012), NT-proBNP (hazard ratio, 1.00; P = 0.001), and WBC count (hazard ratio, 1.10; P = 0.033) were independently related with in-hospital death. As a single marker, WBC count had the highest sensitivity at 84.6% (specificity 65.9%).Admission SBP, NT-proBNP, and WBC count were potential independent risk factors of in-hospital death in Stanford type A AAD patients. WBC count may be a more accurate predictor of type A AAD than either alone. (Int Heart J 2016; 57: 622-626)

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“…Aortic dissection (AD) is a life-threatening cardiovascular disease with high mortality [ 1 ] . Multiple abnormalities have been suggested to contribute to predisposition for this disease, mainly including hypertension, degeneration and genetic disorders [ 2 , 3 ] .…”

Section: Introductionmentioning

confidence: 99%

Safety and Feasibility Study of a Novel Stent-Graft for Thoracic Endovascular Aortic Repair: a Canine Model Experiment

Yang¹,

Qiu²,

Fu³

et al. 2017

Braz J Cardiovasc Surg

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ObjectiveTo evaluate the safety and feasibility of a novel stent-graft for thoracic endovascular aortic repair (TEVAR) in a canine model, 9 adult hybrid dogs were used for the experiment.MethodsAll animals were implanted with a novel thoracic aortic stent-graft via femoral artery. Blood sample was collected at pre-operation and 1, 2, 4, 8 and 12 weeks after implantation for hematological examination. Moreover, tissues from randomly selected 4 dogs were subjected to histopathological analysis with the optical microscope after stent-grafts were implanted for 3, 6, 9, and 12 months respectively. The experimental period lasted for more than 2 years.ResultsA total of 9 stent-grafts were successfully implanted in the canine thoracic aortas and no migration or deformation occurred. Related indicators of blood routine, inflammatory factors, and immunology changes were not significantly (P>0.05), except the white blood cell (WBC) counts in the first week. Moreover, abnormal morphology was not found in all thoracic aortas via histopathological examination. Additionally, all stent-grafts were patent and did not migrate, and there was no thrombus in the lumens of stent-grafts.ConclusionThe novel thoracic aortic stent-graft made in China was safe and feasible for thoracic endovascular aortic repair in a canine model.

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Circadian Variation of Acute Aortic Dissection

Cited by 10 publications

References 31 publications

Prognostic Impact of Blood Pressure Change Patterns on Patients With Aortic Dissection After Admission

Prognostic Impact of Blood Pressure Change Patterns on Patients With Aortic Dissection After Admission

Biomarkers Investigation for In-Hospital Death in Patients With Stanford Type A Acute Aortic Dissection

Safety and Feasibility Study of a Novel Stent-Graft for Thoracic Endovascular Aortic Repair: a Canine Model Experiment

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