Frequency of Cardiovascular Complications and Its Association with Prognosis of COVID-19 Patients

Short-term effects of air pollution and weather changes on the occurrence of acute aortic dissection in a cold region

Background

Air pollution and severe weather conditions can adversely affect cardiovascular disease emergencies. Nevertheless, it remains unclear whether air pollutants and low ambient temperature can trigger the occurrence of acute aortic dissection (AAD) in cold regions.

Methods

We applied a retrospective analysis to assess the short-term effects of air pollution and ambient temperature on the occurrence of AAD in Harbin, China. A total of 564 AAD patients were enrolled from a major hospital in Harbin between January 1, 2017, and February 5, 2021. Weather condition data and air pollutant concentrations, including fine particulate matter smaller than 10 μm (PM10) and 2.5 μm in diameter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3), were collected every day. Conditional logistic regressions and correlation analysis were applied to analyze the relationship of environmental and atmospheric parameters with AAD occurrence at lags of 0 to 7 days. Specifically, we appraised the air quality index, CO, NO2, SO2, O3, PM10, PM2.5, temperature, dew point temperature, atmospheric pressure, and cloud amount.

Results

A total of 1,496 days at risk were assessed, of which 564 patients developed AAD. Specifically, AAD did not occur on 1,043 (69.72%) days, while 1 or more cases occurred on 453 (30.28%) days. Several pollution and weather predictors for AAD were confirmed by multilevel modeling. The air quality index (p = 0.0012), cloud amount (p = 0.0001), and concentrations of PM2.5 (p = 0.0004), PM10 (p = 0.0013), NO2 (p = 0.0007) and O3 (p = 0.0001) predicted AAD as early as 7 days before the incident (lag of 7 days) in the study period. However, only concentrations of the air pollutants NO2 (p = 0.0468) and O3 (p = 0.011) predicted the occurrence of AAD after the COVID-19 outbreak. Similar predictive effects were observed for temperature, dew point temperature, and atmospheric pressure (all p < 0.05) on all days.

Conclusion

The risk of AAD is closely related to air pollution and weather characteristics in Harbin. While causation was not determined, the impact of air pollutants on the risk of AAD was reduced after the COVID-19 outbreak.

Silent Type-B Aortic Dissection Accidentally Discovered in a COVID-19-Positive Patient

Aortic dissection is a critical medical condition that poses a significant threat to life, and if left untreated, it can lead to high mortality and morbidity rates. The risk of various cardiovascular complications, including aortic dissection, is increased in individuals with coronavirus disease 2019 (COVID-19). However, the significance of aortic dissection as a complication in COVID-19 patients is often underestimated. Traditionally, aortic dissection without pain was considered uncommon. However, recent information indicates that symptoms in patients with aortic dissection can be more diverse than previously believed. The classic symptoms of tearing chest, back, or abdominal pain may be absent, making diagnosis challenging. We present the incidental detection of an asymptomatic Stanford type-B aortic dissection during a computed tomography (CT) scan conducted to evaluate COVID-19. The patient was managed through conservative treatment.

Aortic dissection and Covid-19; a comprehensive systematic review

Coronavirus disease 19 (Covid-19) has been declared as a pandemic disease since March 2020; causing wide array of signs and symptoms, many of which result in increased mortality rates worldwide. Although it was initially known as an acute respiratory disease, Covid-19 is accompanied with several extrapulmonary manifestations, of which the cardiovascular ones are of major importance. Among other cardiovascular complications of Covid-19, aortic dissection has been a significant yet underrated problem. The pathophysiology of aortic dissection consists of various inflammatory pathways, that could be influenced by Covid-19 infection. We herein have reviewed articles inclusive of aortic dissection concurrent with Covid-19 infection in a systematic manner, along with the probable similarities in pathophysiology of aortic dissection with Covid-19 infection.