Towards prediction of the incidence of acute aortic dissection type A

Acute aortic dissection (AAD) is the third main driver of the out-of-hospital immediate death (Manfredini et al., 2008). Despite the state-of-the-art therapeutic and diagnostic methods, AAD develops hastily with often fatal consequences. Although the AAD was first reported more than two centuries ago there is still less knowledge about the origins and causes of it (Hagan et al., 2000). Environmental factors may influence the onset of cardiovascular incidents like acute myocardial infraction, rupture of intracranial aneurysm or abdominal aorta (Benouaich et al., 2010). Using a dataset of n=464 patients' history, Hagan et al., 2000 showed that the mortality of type A AAD (n=289) was about 26% for those who received surgery and 58% who did not receive surgery. Previous studies indicate that the incidence of AAD follows a non-random behavior (Benouaich et al., 2010; Mehta et al., 2002;Manfredini et al., 2013; Verberkmoes et al., 2012; Sumiyoshi et al., 2002; Mehta et al., 2005). Many studies referred to the existence of a chronobiological behavior in the occurrence of AAD. Winter and Autumn months present a higher risk of occurrence of AAD (Talbot and Langman, 1972; Castelden and Mercer, 1985; Liapis et al., 1992; Kobza et al., 2002; McCarthy et al., 2003; Harkin et al., 2005; Manfredini et al., 2008; Benouaich et al., 2010). The existence of chronobiological variations in AAD leads to the question whether there is a linkage between weather or climatic conditions and the incidence of AAD and to what extend it could be predicted? The linkage between the onset of cardiovascular and cerebrovascular diseases in different countries has been investigated in several studies. However, the results are controversial (Dilaveris et al., 2006). Up to now very few studies investigated the bioclimatic origins of the AAD (eg. Benouaich et al., 2010; Verberkmoes et al., 2012; Ishikawa et al., 2012). According to Bennouaich et al., 2010, the cold weather and temperature decrease may play a major role in frequency of AAD incidence. They investigated the medical reports of 206 patients who received surgery for type A AAD in Toulouse University hospital during 1997 to 2007. However, they proposed further investigations of such correlations. Using a data set of n=11.412 patients during the January 1998 to February 2010, Verberkmoes et al., 2012, found that a higher risk of AAD occurs in cold weathers. The study of Ishikawa et al., 2012, was the unique study that investigated a combination of several detailed meteorological parameters and vascular diseases. Previous studies mostly focused on the relation between a single climatic parameter and the particular disease. The weather is a chaotic system whose evolution is hard to predict (predictions of up to ten days are possible). The atmosphere is influenced by its interaction with ocean, land and ice which response to the solar heating. The interaction and feedback processes between different components of the climate system are still not fully known. With rising greenhouse gases concentration after the industrial revolution, the physical-chemical-biological conditions present extreme chaotic behavior. Here, we propose using a new methodology, which considers the different weather phases instead of single or several meteorological variables. To our knowledge, all previous studies utilized the meteorological variables in a single atmospheric level (e.g. surface level) and in a single or several meteorological stations located close to the target Hospital. The teleconnection and the feedback processes between the different atmospheric layers and their spatial patterns are invisible to such approaches. The weather phases are characterized by different dynamical weather processes. By clustering the weather conditions into different phases, we consider the relation between different meteorological variables in both time and space. The main focus of this study is to answer the question whether there is a relationship between different weather phases and the incidence of type A AAD in Berlin area.