Acute coronary syndrome (ACS) in patients with COVID-19 is triggered by various mechanisms and can significantly affect the patient’s further treatment and prognosis. The study aimed to investigate the characteristics, major complications, and predictors of mortality in COVID-19 patients with ACS. All consecutive patients hospitalized from 5 July 2020 to 5 May 2021 for ACS with confirmed SARS-Co-2 were prospectively enrolled and tracked for mortality until 5 June 2021. Data from the electronic records for age and diagnosis, matched non-COVID-19 and COVID-19 ACS group, were extracted and compared. Overall, 83 COVID-19 ACS patients, when compared to 166 non-COVID ACS patients, had significantly more prevalent comorbidities, unfavorable clinical characteristics on admission (acute heart failure 21.7% vs. 6.6%, p < 0.01) and higher rates of major complications, 33.7% vs. 16.8%, p < 0.01, and intrahospital 30-day mortality, 6.7% vs. 26.5%, p < 0.01. The strongest predictors of mortality were aortic regurgitation, HR 9.98, 95% CI 1.88; 52.98, p < 0.01, serum creatinine levels, HR 1.03, 95% CI 1.01; 1.04, p < 0.01, and respiratory failure therapy, HR 13.05, 95% CI 3.62; 47.01, p < 0.01. Concomitant ACS and COVID-19 is linked to underlying comorbidities, adverse presenting features, and poor outcomes. Urgent strategies are needed to improve the outcomes of these patients.
Gestational hypertension (GH) is one of the entities of the hypertensive disorders in pregnancy (HDP), a major cause of maternal, fetal, and neonatal morbidity and mortality. Also, the HDP have been recognized as an important risk factor for cardiovascular diseases. Thus, women who develop GH or preeclampsia (PE) are at increased risk of hypertension, ischemic heart disease and stroke in later life. An ambulatory blood pressure monitoring (ABPM) takes an important role in diagnosing of hypertension in pregnancy. Also, it has been shown that ABPM had higher accuracy in the prediction of GH, premature childbirth and low birth weight, compared with the conventional blood pressure (BP) measurements. In addition, we have found that non-dipping pattern of BP is very highly related with worse pregnancy outcome in a term of preterm delivery and intrauterine growth restriction. Also, it is associated with worse maternal hemodynamics, more impaired systolic function and more pronounced cardiac remodeling compared to women with GH and dipping pattern of BP. This review aimedtoexplorethe(a)currentclassificationsoftheHDP;(b)pathogenesisofGHandPE;(c) physiological changes of BP and maternal hemodynamics in pregnancy; and (d) pathophysiological changes of BP and maternal cardiac function, especially in a term on BP pattern.
Background It is known that gestational hypertension (GH) and preeclampsia have been associated with the onset of hypertension later in life. We wondered if the blood pressure (BP) pattern affects the incidence of hypertension in the future. Purpose The aim of this study was to determine whether hypertension occurs more frequently if a non-dipping pattern was registered during GH, but also if non-dipping pattern in GH afects deterioration of systolic function of the left ventricle (LV) later in life. Methods This longitudinal study included 56 pregnant women with gestational hypertension (of which 28 met criteria for non-dipping pattern of BP, according to the values registrated by the ambulatory blood pressure monitoring (ABPM) – non-dippers, while other 28 were classified in dippers) and 27 normotensive pregnant women, as control. All of women became normotensive after delivery, but they continued to be periodically controlled in term of values of blood pressure. The function and morphology of the left ventricle (LV) were analyzed by echocardiography exam in the third trimester of pregnancy and 5 years after delivery, as well as ABPM, while 2D longitudinal strain (LS) was performed only after delivery in order to evaluate systolic function of the LV. All echo and ABPM parameters recorded during pregnancy, also as parameters of pregnancy outcome – intrauterine growth restriction (IUGR) and preterm delivery, were analyzed, in order to relate them with later onset of hypertension. Results After, average 5 years, diagnosis of hypertension was determined in 8 women (2 from dipper group – during pregnancy – 7,1%, and 6 from non-dipper group 21,4%). Those 8 hypertensive women had significantly reduced LS: −18,12±1,3 compared to normotensive −19,9±1,4 (p=0,001). It is very interesting that, 5 years after delivery, values of 2D LS were, although in reference values, significantly reduced in women who were non-dippers (−19,32±1,38) during GH, compared with both, normotensive (−20,69±1,18; p<0,0005) and dippers (−20,10±1,29; p=0,026). Univariate regression analysis revealed that higher values of day and night BP, the mean arterial BP, LV mass index, preterm delivery and IUGR were associated with onset of hypertension later in life, while parameters of systolic and diastolic function of the LV during pregnancy, didn't affect occurrence of it. As revealed by multivariate regression analysis, the peak value of night-time diastolic blood pressure during pregnancy (p=0,016; OR=1,127; 95% CI: 1,022–1,242) and the LV mass index, also during pregnancy (p=0,041; OR=1,099; 95% CI: 1,004–1,203) had strong relation with hypertension in future life. Conclusion The non-dipping pattern of blood pressure in gestationl hypertension is significant associate with onset of hypertension later in life, but also with decreased systolic function of the left ventricle. Acknowledgement/Funding Provincial Secretariat for Health of the Autonomous Province of Vojvodina
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