Methods: A population of 363 untreated hypertensives was investigated using a standardised procedure. The men and women were analysed separately. We studied the relationship between mean daytime ambulatory sys-
Ambulatory measurement of timing of Korotkoff sounds (QKD interval) gives an estimate of arterial distensibility derived from the velocity of the pulse wave over a vascular territory that includes the ascending aorta. The main advantages of the method are that it is entirely automatic, non-operator-dependent, and highly reproducible, and produces a measure independent of instantaneous blood pressure. This study of a group of 180 normal subjects aged between 10 and 78 years was designed to produce references values and to study the influence of height. The results confirmed the reduction with age of arterial distensibility in the whole population. However before the age of 30, QKD100-60 was positively correlated with height according to the relationship QKD100-60 = 0.73 height (cm) + 91, but not with age. This equation enables calculation of the theoretical value of QKD100-60 as a function of height for any patient to which the observed value can be expressed as a percentage. This effectively eliminates the influence of height, which reflects the length of the arterial segment under investigation.
Relationships between ambulatory arterial pressure and arterial distensibility as assessed by ambulatory measure of the QKD interval and echocardiographic measurement of left ventricular mass and relative wall thickness were evaluated in a population of 163 untreated hypertensive patients. The height-corrected QKD100-60 interval was significantly correlated with left ventricular mass (LVM; r = -0.29, P<.001) and with relative wall thickness (r = -0.31, P<0.001). In a multivariate analysis, LVM was significantly correlated with mean arterial pressure, pulse pressure, and age, whereas the relative wall thickness was correlated with the QKD interval and the mean arterial pressure. The concentric character of the LVH of the hypertensive patient was thus linked to the reduction in arterial distensibility.
There is a significant and independent positive relationship between serum cholesterol level and left ventricular mass that could contribute to the prognostic value of left ventricular hypertrophy.
Background
The novel coronavirus (COVID-19) has presented a significant and urgent threat to global health and there has been a need to identify prognostic factors in COVID-19 patients. The aim of this study was to determine whether chest CT characteristics had any prognostic value in patients with COVID-19.
Methods
A retrospective analysis of COVID-19 patients who underwent a chest CT-scan was performed in four medical centers. The prognostic value of chest CT results was assessed using a multivariable survival analysis with the Cox model. The characteristics included in the model were the degree of lung involvement, ground glass opacities, nodular consolidations, linear consolidations, a peripheral topography, a predominantly inferior lung involvement, pleural effusion, and crazy paving. The model was also adjusted on age, sex, and the center in which the patient was hospitalized. The primary endpoint was 30-day in-hospital mortality. A second model used a composite endpoint of admission to an intensive care unit or 30-day in-hospital mortality.
Results
A total of 515 patients with available follow-up information were included. Advanced age, a degree of pulmonary involvement ≥ 50% (Hazard Ratio 2.25 [95% Cl: 1.378 to 3.671], p= 0.001), nodular consolidations and pleural effusions were associated with lower 30-day in-hospital survival rates. An exploratory subgroup analysis showed a 60.6% mortality rate in patients over 75 with ≥ 50% lung involvement on a CT-scan.
Conclusions
Chest CT findings such as the percentage of pulmonary involvement ≥ 50%, pleural effusion and nodular consolidation were strongly associated with 30-day mortality in COVID-19 patients. CT examinations are essential for the assessment of severe COVID-19 patients and their results must be considered when making care management decisions.
SummaryBackground: Hypertension is accompanied by abnormalities in left ventricular filling; however, there is a lack of agreement on the extent of the influence of antihypertensive treatment on them.Hypothesis: The present study was designed to evaluate the long-term course of these abnormalities in both treated and untreated hypertensive patients.
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