Circadian Variation in the Rupture of Abdominal Aortic Aneurysms

Abstract

Circadian variations in the incidence of myocardial infarction, sudden death, and stroke have been attributed to diurnal fluctuations in catecholamine release, blood pressure, heart rate, fibrinolytic activity, and platelet aggregation. As similar factors could precipitate the rupture of an abdominal aortic aneurysm, a retrospective chart review was undertaken in an effort to define the timing of aneurysm rupture and any associated circadian variation.

One hundred forty-three patients with a ruptured abdominal aortic aneurysm (rAAA) and a documented time of presentation were evaluated. Eighty-one patients (56.7%) presented within 2 hours of the onset of symptoms and were examined for diurnal variability in their presentation. The hourly rate of rAAA presentation between 8 AM and 10 PM (4.3 per hour) was more than twice that observed during the night (2.1 per hour, p<0.001). The distribution of presentation times among this group was significantly different from uniform (p=0.05), implying circadian variability to aneurysm rupture. The time-dependent rate of rAAA presentation could be predicted (R²=0.77) with cosinor regression methods, although this model was not statistically significant (F= 4.9, p >0.10).

Abdominal aortic aneurysm rupture occurs with a diurnal variation having a peak during waking hours. The relationship of aneurysm rupture to known physiological circadian rhythms may give further insight into the underlying pathophysiology and has implications for patient management.

Get full access to this article

View all access options for this article.

References

1. Muller J , Stone P , Turi Z , et al: Circadian variation in the frequency of acute myocardial infarction. N Engl J Med 313:1315-1322, 1985.

2. Muller J , Ludmer P , Willich S , et al: Circadian variation in the frequency of sudden cardiac death. Circulation 75:131-138, 1987.

3. Gallerani M , Manfredi R , Ricci L , et al: Chronobiological aspects of acute cerebrovascular diseases. Acta Neurol Scand 87:482-487, 1993.

4. Gallerani M , Trapella G , Manfredi R , et al: Acute intracerebral hemorrhage: Circadian and circannual patterns of onset. Acta Neurol Scand 89:280-286, 1994.

5. Natali G , Acitelli P , Cicogna S , et al: Essential hypertension: Chronobiological study of the circadian variations in urinary excretion of free catecholamines. Chronobiologia 9:99-105, 1982.

6. Millar-Craig M , Bishop C , Raftery E : Circadian variation of blood pressure. Lancet 1:795-797, 1978.

7. Andreotti F , Davies G , Hackett D . et al: Major circadian fluctuations in fibrinolytic factors and possible relevance to time of onset of myocardial infarction, sudden cardiac death, and stroke. Am J Cardiol 62:635-637, 1988.

8. Rosing D , Brakman P , Redwood D , et al: Blood fibrinolytic activity in man. Circ Res 27:171-184, 1970.

9. Jafri S , Van Rollins M , Ozawa T , et al: Circadian variation in platelet function in healthy volunteers. Am J Cardiol 69:951-954, 1992.

10.

10. Cronenwett J , Murphy T , Zelenock G , et al: Actuarial analysis of variables associated with rupture of small abdominal aortic aneurysms. Surgery 98:472-483, 1985.

11.

11. Varty K , Reid A , Bell P : Vascular emergencies: What's in season? Cardiovasc Surg 3:409-411, 1995.

12.

12. Castleden W , Mercer J : Abdominal aortic aneurysms in Western Australia: Descriptive epidemiology and patterns of rupture. Br J Surg 72:109-112, 1985.

13.

13. Liapis C , Sechas M , Iliopoulos D , et al: Seasonal variation in the incidence of ruptured abdominal aortic aneurysm. Eur J Vasc Surg 6:416-418, 1992.

14.

14. Manfredini R , Portaluppi F , Gallerani M , et al: Seasonal variations in the rupture of abdominal aortic aneurysms. Jpn Heart J 38:67-72, 1997.

15.

15. Johansen K , Kohler T , Nicholls S , et al: Ruptured abdominal aortic aneurysm: The Harborview experience. J Vasc Surg 13:240-247, 1991.

16.

16. Nelson W , Tong Y , Halberg F , et al: Methods for cosinorrhythmometry. Chronobiologia 131:305-323, 1979.

17.

17. Mitler M , Hajdukovic R , Hahn P , et al: Circadian rhythm of death time: Cause of death versus recorded death time in New York City (abstract). Sleep Res 14:306-306, 1985.

18.

18. Mitler M , Hajdukovic R , Shafor R , et al: When people die: Cause of death versus time of death. Am J Med 82:266-274, 1987.

19.

19. Dawkins K , Muers M : Diurnal variation in airflow obstruction in chronic bronchitis. Thorax 36:618-621, 1981.

20.

20. Hetzel M , Clark T : Comparison of normal and asthmatic circadian rhythms in peak expiratory flow rate. Thorax 35:732-738, 1980.

21.

21. Cannon D , Read R : Blood elastolytic activity in patients with aortic aneurysm. Ann Thorac Surg 34:10-15, 1982.

22.

22. Cohen J , Mandell C , Margolis I , et al: Altered aortic protease and antiprotease activity in patients with ruptured abdominal aortic aneurysms. Surg Gynecol Obstet 164:355-358, 1987.

23.

23. Blue M , Janoff A : Possible mechanisms of emphysema in cigarette smokers. Am Rev Respir Dis 117:317-325, 1978.

24.

24. Leach S , Toole A , Stern H , et al: Effect of 1-adrenergic blockade on the growth rate of abdominal aortic aneurysms. Arch Surg 123:606-609, 1988.