Journal of Emergencies, Trauma, and Shock
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 Table of Contents    
LETTER TO EDITOR  
Year : 2014  |  Volume : 7  |  Issue : 3  |  Page : 244-246
Acute aortic dissection is independent of weather conditions but statistically correlates with day of the week


1 Department of Cardiac Surgery, Onassis Cardiac Centre, Athens, Greece
2 Department of Cardiovascular and Thoracic Surgery, Larissa University Hospital, Larissa, Greece
3 Department of Cardiology, Larissa University Hospital, Larissa, Greece
4 Department of Biomathematics, School of Medicine, University of Thessaly, Larissa, Greece

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Date of Web Publication16-Jul-2014
 

How to cite this article:
Karangelis D, Daskalopoulos M, Giamouzis G, Koufakis T, Fragoulis S, Papadakis E, Kalafati G, Tsilimingas N. Acute aortic dissection is independent of weather conditions but statistically correlates with day of the week. J Emerg Trauma Shock 2014;7:244-6

How to cite this URL:
Karangelis D, Daskalopoulos M, Giamouzis G, Koufakis T, Fragoulis S, Papadakis E, Kalafati G, Tsilimingas N. Acute aortic dissection is independent of weather conditions but statistically correlates with day of the week. J Emerg Trauma Shock [serial online] 2014 [cited 2018 Feb 22];7:244-6. Available from: http://www.onlinejets.org/text.asp?2014/7/3/244/136877


Dear Editor,

Acute aortic dissection (AAD) is the most common life-threatening disease involving the aorta. Despite the fact that lot of risk factors have been incriminated for AAD such as hypertension, connective tissue disorders, autoimmune diseases, drug use and bicuspid aortic valve, the factors triggering the initiation process of the dissection have not been fully elucidated. A statistical correlation between weather/meteorological conditions and the incidence of cardiovascular events has previously been described. [1] We aimed to evaluate the daily, monthly, and seasonal distribution of incident type A of AAD and its association with the variability of specific meteorological parameters, such as atmospheric pressure, temperature, wind and humidity.

We defined as onset of the AAD, the earliest time of symptoms as reported by the patient, relatives, or witnesses. We managed to determine the precise time of symptom onset (within one hour) in all our patients. Patients were assessed by means of echocardiogram and spiral computed tomography (CT).

Data were collected from January 2007 to December 2012.

The population comprised of 54 patients (mean age 61.2 ± 11.6 years). The distribution of dissections through the year is presented in [Figure 1]. while the seasonal and daily variations of AAD are presented in [Figure 2] and [Figure 3]. respectively.
Figure 1: Monthly distribution of AAD. The frequency in March was found 5 times higher than in May.

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Figure 2: Seasonal distribution of AAD. No statistical signifi cance was highlighted in regards to variation of AADs onset as was observed among seasons (P = 0.670). Our study did not demonstrate any statistical correlation between seasons and AADs. However, central Greece does not have the marked seasonal variations in temperature (especially extreme winter cold) that are experienced in more Northern countries, where most positive studies have been conducted.

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Figure 3: Daily distribution of AAD. The daily distribution of AADs revealed signifi cant differences (P = 0.008): the frequency of AADs was 15 times higher on Monday than Saturday and 3.75 times higher on Monday than Sunday. The frequency of AADs on Tuesday was 8 times higher than Saturday. Furthermore, the frequency of AADs occurrence on Wednesday was 8 times higher than Saturday. Finally, the comparison between weekdays revealed that AADs occurrence on Thursday was 12 times higher than Saturday.

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Regarding monthly variation, AADs occurrence was equally distributed in general (P = 0.381), with only some month-to-month comparisons demonstrating significant differences (e.g. March vs. May, frequency 5 times higher; [Figure 1]). The meteorological data collected for the 3 peri-dissection days (the day of the incidence and the two previous days), showed that the onset of AADs is independent of any change in environmental factors [Table 1]. The key element of this study is the high prevalence of AADs in the start of the week and midweekly compared with the prevalence in the weekend [Figure 3]. This finding corresponds with the demanding lifestyle and the taxing rhythms of the contemporary era that most people confront in week time and not on weekends. It is well known that emotional and occupational stresses, which mostly occur during the workweek, are important triggers of acute cardiovascular events. [2],[3] Emotional stress and job strain have emerged as the precipitating factors for acute coronary events and myocardial infarction, with the trigger mechanism being hypertension. [4],[5]
Table 1: Comparison of meteorological parameters the day of the AAD and the 2 preceding days

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Conventional wisdom suggests that throughout the workweek the combination of an active or high-strain job along with the frenzied professional rhythms have a major impact on our health; by comparison, weekends provide a milieu of relative rest and leisure. Therefore, it is not surprising that the frequency of AAD on Mondays was 15 times higher than Saturdays and 3.75 times higher than Sundays in the present study.

The occurrence of AAD was not associated with rapid alterations in atmospheric pressure, temperature, humidity, and wind in the present study. Moreover, the distribution of AADs did not display seasonal variations. Nevertheless, the daily incidence of AADs revealed an impressive distribution, being significantly more frequent on Mondays than on weekends. This finding implies involvement of emotional and occupational stresses that may precipitate transient severe hypertensive responses and deserves further investigation.

The continuous variables were expressed as mean ± standard deviation. The chi-square goodness-of-fit statistic was run to test whether the seasonal, monthly, weekly, and daily distribution of incident, AADs, followed a uniform distribution. Temperature, pressure, wind and humidity recordings were obtained for this period from the National Meteorological Office. Mean values of the weather conditions from the specific day of the aortic dissection were compared to the data of the two days preceding the incidence. Meteorological parameters were compared with one-way analysis of variance (ANOVA). The statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 18.0; level of significance for all tests was considered significant at P < 0.05). Prior to enrollment, all the patients gave informed consent according to the local institutional ethical guidelines. The protocol was approved by the institutional review board of the Hospital.

There were 39 males (mean age 60.9 ± 11.7) and 15 female patients (mean age 62.1 ± 11.6). In the majority of patients [42 out of 54 (77.7%)] the predominant symptom was severe, unrelenting chest pain with an abrupt onset, while 12 out of 54 (22.3%) complained of chest pain irradiating to the back and shoulders. The elapsed time (min) from the onset of pain of the AAD, until the patient was delivered to cardiothoracic care was 181.7 ± 122.1 (range: 90-880) minutes. Transthoracic echocardiography was initially performed in every patient in the emergency setting; however, the diagnosis of AAD was based on findings from the spiral CT scan. Onset of AADs was independent of any change in environmental factors (not statistically significant). The attenuation of such weather variations observed in the mild Mediterranean climate in central Greece could explain this lack of statistical significance as well.

 
   References Top

1.Repanos C, Chadha NK. Is there a relationship between weather conditions and aortic dissection? BMC Surg 2005;5:21.  Back to cited text no. 1
    
2.Hammoudeh AJ, Alhaddad IA. Triggers and the onset of acute myocardial infarction. Cardiol Rev 2009;17:270-4.  Back to cited text no. 2
    
3.Uchiyama S, Kurasawa T, Sekizawa T, Nakatsuka H. Job strain and risk of cardiovascular events in treated hypertensive Japanese workers: Hypertension follow-up group study. J Occup Health 2005;47:102-11.  Back to cited text no. 3
    
4.Hatzaras IS, Bible JE, Koullias GJ, Tranquilli M, Singh M, Elefteriades JA. Role of exertion or emotion as inciting events for acute aortic dissection. Am J Cardiol 2007;100:1470-2.  Back to cited text no. 4
    
5.Edwin F, Aniteye EA, Sereboe L, Frimpong-Boateng K. eComment: Acute aortic dissection in the young-distinguishing precipitating from predisposing factors. Interact Cardiovasc Thorac Surg 2009;9:368.  Back to cited text no. 5
    

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Correspondence Address:
Dimos Karangelis
Department of Cardiac Surgery, Onassis Cardiac Centre, Athens
Greece
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2700.136877

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