Examining the Relationship Between Triggering Activities and the Circadian Distribution of Acute Aortic Dissection

Abstract

Background and ObjectivesThere are limited data examining triggering activities and circadian distribution at the onset of acute aortic dissection (AAD) in the context of diagnostic and anatomical classification. The aim of this study was to further investigate this relationship between triggering activities and circadian distribution at the onset of AAD according to diagnostic and anatomic classification.Subjects and MethodsA total of 166 patients with AAD admitted to Kyungpook National University Hospital between July 2001 and June 2009 were included. To assess the influence of diagnostic and anatomical classification, we categorized the patients into intramural hematoma (IMH) group (n=67)/non-IMH group (n=99) and Stanford type A (AAD-A, n=94)/type B (AAD-B, n=72). To evaluate circadian distribution, the day was divided into four 6-hour periods: night (00-06 hours), morning (06-12 hours), afternoon (12-18 hours), and evening (18-00 hours).ResultsMost (72%) AAD episodes were related to physical (53%) and mental activities (19%), with about one-third occurring during the afternoon, and only 12% occurring at night. No differences in triggering activities or circadian distribution were observed among the groups. Waking hours including morning, afternoon, and evening correlated with triggering activities (p=0.003). These relationships were observed for the non-IMH (p=0.008) and AAD-B (p=0.003) cases. The remaining categories had similar relationships, but did not reach statistical significance.ConclusionOur findings suggest differences in the relationship between triggering activities and the circadian distribution of the onset of AAD according to diagnostic and anatomical classification.

Chronologic and Climatic Factors of Acute Aortic Dissection: Study of 1642 Patients in Two Continents

“…One of the different findings of this study was a peak of AAD occurrence on Wednesday in both centers. Although Lasica and associates 20 and Ryu and associates 21 also reported a Wednesday peak, most literature documented a peak of dissection onset on Monday. 5,8,22,23 The Monday peak was ascribed to the emotional stress of starting weekly work activities, 24 less favorable biochemical factors (such as carbohydrate and lipid levels), 25 and higher blood pressure levels 26 on Monday compared with other days of the week.…”

The Chronobiology of Stanford Type A Aortic Dissections

“…Other hemodynamic factors would include underlying chronic hypertension, acute hypertensive episodes as well as other extrinsic events. Ryu et al [9], in their small series of 166 patients with STADs, found that 72% of the STAD episodes were associated with either physical (53%) or mental (19%) activities. Hatzaras et al [10] documented 31 patients with an acute STAD associated with intense physical exertion, predominantly weightlifting.…”