Korean Circ J.  2010 Nov;40(11):565-572. 10.4070/kcj.2010.40.11.565.

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

• Ryu HM
• Lee JH
• Kwon YS
• Park SH
• Lee SH
• Bae MH
• Lee JH
• Yang DH
• Park HS
• Cho Y
• Chae SC
• Jun JE
• Park WH

• KMID: 1826175
• DOI: http://doi.org/10.4070/kcj.2010.40.11.565

Abstract

BACKGROUND AND OBJECTIVES
There 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 METHODS
A 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).
RESULTS
Most (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.
CONCLUSION
Our findings suggest differences in the relationship between triggering activities and the circadian distribution of the onset of AAD according to diagnostic and anatomical classification.

Keyword

Dissection; Aorta; Circadian rhythm

MeSH Terms

Aorta
Circadian Rhythm
Hematoma
Humans

Figure

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  Fig. 1 The chronobiological distribution of onset of acute aortic dissection (AAD). A: AAD occurred most frequently in winter (33%) followed by spring (26%), autumn (22%), and summer (19%). B: AAD occurred most frequently in December and January (11%), and least frequently in August (4%), closely followed by September (5%). C: There was homogeneity in weekly distribution. D: AAD occurred most frequently at 12-14 hours (13%) followed by 18-20 hours (11%), 14-16 hours (11%), 16-18 hours (10%), 20-22 hours (10%), and 06-08 hours (10%). About one-third of AAD episodes occurred during the afternoon (bars with dark horizontal line) while the fewest (12%) occurred at night (bars with shallow left-downward line).

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  Fig. 2 The relationship between triggering activities and the circadian distribution of onset of acute aortic dissection (AAD). Presence of triggering activities was related to circadian distribution (p=0.003) (A). There was a trend towards triggering activities and the circadian distribution of the onset of AAD in the Stanford type A group (p=0.197), but the difference did not reach statistical significance (B). The relationship between triggering activities and the circadian distribution of AAD onset held in the Stanford type B group (p=0.003) (C). The relationship between triggering activities and the circadian distribution of the onset of AAD held for the non-intramural hematoma group (p=0.008) (D). There was a trend towards a relationship between triggering activities and circadian distribution of the onset of AAD in the intramural hematoma group (p=0.102), but the difference did not reach statistical significance (E). The distribution of triggering activities of the onset of AAD within four 6-hour periods was tested for uniformity in the overall population, and in the patient's subgroups by the Chi-square test for goodness of fit. A Chi-square value large enough to reject the hypothesis implied nonuniformity.

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