Aesthetics and evaluation of objects is becoming increasingly important in contemporary society. Although there have been many studies on processes related to computational aesthetic, a clear ...formalisation and visualization of the aesthetic field is still lacking. In this paper, we present a set of Machine Learning techniques and mathematical methods to extract the most important features related to aesthetical evaluation, thus making this process automatic, without the human intervention. The techniques are then applied to a sample of 83 images of triangles, produced by artists. The results of the empirical method provide a series of measurements that allow the extrapolation of mathematical aesthetic characteristics of the images and their location in the aesthetic space.
•We propose a framework to analyse the space of aesthetic cognition.•We developed a set of metrics capable to detect aesthetical features of data from a mathematical point of view.•We applied the techniques to 83 textured triangles, produced by artists, using computational methods.•The results were visualised in multidimensional planes, and then visualised in two- and three-dimensional spaces.•Results were interpreted with the Points Process Model, which gave us a Probability Distribution Function of the whole aesthetic landscape.•Aesthetic measures for each element of the samplehave been obtained, together with specific traits which share aesthetic features of the same type.
•State of art of management and treatment of hypertension emergency/urgency in Italy.•Good knowledge of definition and treatment.•Fair quality of blood pressure measurement technique.•Lack of ...protocol or fast track for this problem.•Differences in terms of treatment and diagnosis across macro-areas.
Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Emergency Department (ED) and the approach may be different according to local clinical practice. Our aim was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of an on-line survey. The young investigator research group of the Italian Society of Hypertension developed a 23-item questionnaire spread by e-mail invitation to the members of Italian Scientific societies in the field of Hypertension. 665 questionnaires were collected from EDs, Emergency and Urgency Medicine, Cardiology or Coronary Units, Internal Medicines, Intensive care, Stroke units. Symptoms considered suspicious of acute organ damage were: chest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%) and epistaxis (34.4%). Exams more frequent prescribed were: electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). The use of intravenous or oral medications to treat HEs was 94.7% and 3.5%, while for HUs 24.4% and 70.8% respectively. Of note, a surprisingly high percentage of physicians (22 % overall, 24.5% in North Italy) used to prescribe sublingual nifedipine. After discharge, home blood pressure monitoring and general practitioner re-evaluation were more frequently suggested, while ambulatory blood pressure monitoring and hypertension specialist examination were less prescribed. The differences observed across the different macro-areas, regarded prescription of diagnostic test and drug administration. This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy.
OBJECTIVE:Hypertensive emergencies (HE) and urgencies (HU) are frequent causes of patients referral to Italian Emergency Department (ED), however the diagnostic and therapeutic approach may differ ...across the Italian country. The aim of the study GEAR (Gestione delle Emergenze e urgenze in ARea critica) was to explore awareness, management, treatment and counselling after discharge of HE and HU in Italy, by mean of on-line survey.
DESIGN AND METHOD:The young investigator research group of the Italian Society of Hypertension developed a 23-items questionnaire spread by e-mail invitation to the members of Italian Scientific societies involved in the field of Emergency Medicine and Hypertension.
RESULTS:665 questionnaires were collected59.7% from EDs, 22% from Emergency and Urgency Medicine wards, 8.7% from Cardiology or Coronary Units, 5.7% from Internal Medicines and 3.9% from Intensive care or Stroke units. The definition of HE and HU was correctly identified by 81.2% and 89.3% of the responders respectively. The symptoms considered suspicious of acute organ damage werechest pain (89.0%), visual disturbances (89.8%), dyspnoea (82.7%), headache (82.1%), dizziness (52.0%), conjunctival haemorrhages (41.5%), tinnitus (38.2%), epistaxis (34.4%). Appropriate cuffs, for different arm sizes, were not widely available in all units94% had standard cuffs, 57% small and 75.6 % large cuffs, extra-large only 38.5%. The exams more frequent prescribed to evaluate target organ damage were electrocardiogram (97.2%), serum creatinine (91.4%), markers of cardiomyocyte necrosis (66.2%), echocardiography (65.1%). HEs were treated by 94.7% of the physicians by intravenous medications and by 3.5% by oral drugs, while HUs were treated by intravenous drugs in 24.4% of the cases and by oral drugs in 70.8%. When patients were discharged from ED, 87.5 % of the responders recommended home blood pressure monitoring, 87.5% general practitioner re-evaluation, while ambulatory blood pressure monitoring and hypertension specialist examination were less frequently recommended.
CONCLUSIONS:This survey depicts a complex situation of shades and lights in the real-life management of HE and HU in Italy. Strong unmet needs clearly emerged, especially for educational initiatives, standardized treatment protocols and interrelationship with the chronic care system.
OBJECTIVE:It has been suggested that measurement of “unattended” or “automated oscillatory (AOBP)” blood pressure values may provide advantages over conventional BP measurement; some hypertension ...guidelines now suggest this approach as the preferred one for measuring office BP. Data on the relationship between AOBP and cardiovascular events are much less solid as compared to those obtained with the standard BP measurement; on the other hand, some study suggested that AOBP might be more strictly correlated with hypertensive target organ damage than “attended” BP.The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and target organ damage in 261 subjects attending the outpatient clinic of an ESH Excellence Centre.
DESIGN AND METHOD:BP values were measured by the physician with an automated oscillometric device (Omron HEM 9000Ai, mean of 3 measurements), after 5 minutes of rest; thereafter, the patient was left alone and unattended BP was measured automatically after 5 minutes (3 measurements at 1 minute interval).
RESULTS:Patientʼs mean age was 61 ± 16 yrs, mean BMI 26.1 ± 4.2, 60% were female, 88 % had a previous diagnosis of hypertension (64% treated). Systolic unattended BP was lower as compared to attended SBP (130.1 ± 15.7vs138.6 ± 17.2 mmHg). Left ventricular mass index (LVMI) was similarly correlated with unattended and attended SBP (r = 0.132 and r = 0.133, p < 0.05, respectively). LVMI was similarly correlated with unattended and attended pulse pressure (PP) (r = 0.277 and r = 0.299, p < 0.05, respectively). Carotid IMT was significantly and similarly correlated with both attended and unattended BP values (CBMaxIMTr = 0.172 and r = 0.153 for attended and unattended SBP, p < 0.05 andr = 0.459 and r = 0.436 for attended and unattended PP, p < 0.001). The differences between correlations were not statistically significant.
CONCLUSIONS:Measurement of BP “unattended” or “unattended” provides different values, being unattended BP lower as compared to attended BP. Our results suggest that attended and unattended BP values are similarly related with cardiac and vascular hypertensive target organ damage.
OBJECTIVE:Left atrial (LA) enlargement (LAE) is associated to an increased risk of cardiovascular complications, and in particular of atrial fibrillation. The 2018 ESH/ESC Hypertension guidelines ...suggested the use of LA volume instead of linear dimensions, and for the first time proposed the indexation to height2(h2)The aim of our study was to assess the prevalence of left atrial dilatation in a large sample of patients undergoing an echocardiogram for cardiovascular risk stratification at an ESH excellence centre in Italy.
DESIGN AND METHOD:3872 subjects undergoing a diagnostic work-up for arterial hypertension (known or suspect) were analysed. The mean age was 56 ± 15 years, BMI 26 ± 5, 44% normal weight, 39% overweight, 17% obese, 53% males. Left atrial volume was measured by the area-length method using the apical 4-chamber and 2-chamber views.
RESULTS:The prevalence of left ventricular hypertrophy (LVH) was 11% when indexing for BSA and 12% when indexing for height2.7. LAE was observed in 30% of subjects when indexing for h2 and in 9% when indexing for BSA. In obese or overweight subjects the prevalence of LAE was 38% of subjects when indexing for h2 and in 11% when indexing for BSA. The different prevalence of LAE was particularly evident in extremely obese patients.LAE was very common in patients with LVH62% and 26% when indexing for h2 and for BSA, respectively. Interestingly, it was frequent also in patients without LVH, in particular when the indexation for h2 was used (25% as compared to 7% when indexing for BSA).
CONCLUSIONS:In a large sample of subjects undergoing a diagnostic work-up for arterial hypertension LAE was frequently observed, particularly when the new indexation proposed by the 2018 ESH/ESC hypertension guidelines was used. Even in the absence of clear-cut LVH, LAE was observed in one quarter of subjects. The indexation to BSA leads to an under-recognition of LAE, in particular in patients with overweight and/or obesity.
OBJECTIVE:It has been suggested that measurement of “unattended” or “automated oscillatory(AOBP)” blood pressure values may provide advantages over conventional BP measurement and some hypertension ...guidelines now suggest this approach as the preferred one for measuring office BP. Data on the strength of the relationship between AOBP and cardiovascular events are limited as compared to those obtained with the standard BP measurement; conflicting data are available on the relationship between hypertensive organ damage and “attended” and “unattended” BP.The aim of our study was to evaluate the relationship between “attended” or “unattended” BP values and arterial stiffness in 108 subjects undergoing a visit and assessment of arterial stiffness at an ESH Excellence Centre.
DESIGN AND METHOD:Both “unattended” BP (patient alone in the room, an oscillometric device programmed to perform 3 BP measurements, at 1 minute intervals, after 5 minutes) and “attended” BP were measured with the same device, on the same day of arterial stiffness assessment, in random order.
RESULTS:Patientʼs mean age was 65 ± 15 yrs, mean BMI 26 ± 4, 43% female, 72 % had hypertension (59% treated). Systolic unattended BP was lower as compared to attended SBP (132.7 ± 17.7vs124.9 ± 15.3 mmHg). A similar correlation was observed between PWV and systolic unattended BP or attended SBP (r = 0.530 and r = 0.535, p < 0.0001, respectively) and between PWV and mean unattended and attended BP (r = 0.408 and r = 0.381, p < 0.0001, respectively). Similar correlations were also observed between PWV and unattended and attended pulse pressure (r = 0.459 and r = 0.480, p < 0.0001). The differences between correlations were not statistically significant (Steigerʼs Z test).No significant difference was observed between the ROC curves of attended and unattended SBP for the presence of increased arterial stiffness (AUC 0.706 vs. AUC 0.730, p for the comparison = ns).
CONCLUSIONS:Measurement of BP “unattended” or “unattended” provides different values, being unattended BP lower as compared to attended BP. Our results suggest that unattended measurement of BP values does not change the relationship with the gold standard measure of arterial stiffness.
OBJECTIVE:Available data indicate that patients with primary aldosteronism (PA) have an increased risk of cardiovascular (CV) events; furthermore, CV risk seems to be, at least in part, independent ...of blood pressure (BP) elevation. Previous studies have shown that patients with PA have a greater prevalence of left ventricular (LV) hypertrophy, which might contribute to the increase in CV risk. Recently, a non-invasive approach for the estimation of LV mechanical efficiency through the calculation of the ratio between stroke work (SW) and heart rate (HR)–pressure product has been proposed by de Simone and coworkers. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography.
DESIGN AND METHOD:The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as SV/HR and indexed to LV mass (MEEi = MEE/LVM) in a large group of patients with primary aldosteronism and in a control group of essential hypertensives (EH). PA was diagnosed in the presence of a positive aldosterone to renin ratio (>30) and post saline aldosterone > 100ng/ml). Ninety-nine patients with PA were compared with 99 EH patients matched for age and BP values.
RESULTS:No differences between groups were observed for age, gender, BMI, BP values, glucose, lipid profile and renal function. LV mass index was greater in PA vs EH (101 ± 34 vs 84 ± 20, gr/m2, p < 0,05); also relative wall thickness was greater in PA vs EH (0.36 ± 0.1 vs 0.32 ± 0.4, p < 0,05). Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in PA vs EH (40 ± 7 vs 43 ± 6, and 18 ± 3 vs 21 ± 2 both p < 0,05). MEEI was lower in PA vs EH (0.44 ± 0.14 vs 0.52 ± 0.10, p < 0,05). A negative correlation was observed between MEEI and aldosterone levels (r = −0.20, p < 0.05).
CONCLUSIONS:In patients with primary aldosteronism MEEI is lower as compared to EH. These findings may contribute to explain the increased risk of CV events in patients with PA.
OBJECTIVE:BackgroundThe CHA2DS2-VASc score is used in patients with atrial fibrillation (AF) for stroke risk stratification. Recent studies have shown that CHA2DS2-VASc is also predictive of ...cardiovascular (CV) events and mortality, whether or not AF is present. Few data are available on the relationship between CHA2DS2-VASc and preclinical organ damage (OD) in the general population.
DESIGN AND METHOD:Aim of our studywas to evaluate the relationship between CHA2DS2-VASc and 10 years Framingham risk scores and preclinical cardiac and vascular organ damage in subjects from a general population.MethodsA total of 478 subjects underwent clinical examination with blood pressure measurement (clinic and 24 hours), and laboratory examinations. Left ventricular (LV) and carotid artery structure were assessed by ultrasound and carotid-femoral PWV was measured. OD was defined according to ESH ESC 2013 Guidelines. CHA2DS2-VASc was calculated as recommended by current AF Guidelines. The Framingham risk score for cardiovascular events (FRS CVD), for stroke (FRS stroke) and for coronary heart disease (FRS CHD) were also calculated.
RESULTS:Resultsmean age was 58 ± 10 (range 43–74 yrs), 44% were males, 69% hypertensives (37% treated). Left ventricular mass index, meanmax IMT and carotid-femoral pulse wave velocity (PWV) were significantly correlated with all the Framingham risk scores as well as with CHA2DS2-VASc (table).(Figure is included in full-text article.)The simultaneous inclusion of CHA2DS2-VASc and FRS (for CVD or Stroke or CHD) in linear regression analysis showed that the relationship between CHA2DS2-VASc and OD is independent of FRS.
CONCLUSIONS:ConclusionsCHA2DS2-VASc score is significantly correlated to preclinical organ damage in patients from a general population.
OBJECTIVE:Epidemiological studies have suggested that even mild enlargement of the ascending aorta may have independent prognostic significance for cardiovascular events. Therefore, some Authors have ...proposed that dilatation of the ascending aorta could be considered as a form of preclinical vascular damage in hypertensive patients. Aim of our studywas to assess the correlation between clinic and 24 hours BP values and the dimensions of the aorta, measured at level of the sinuses of Valsalva (Val), at the left ventricular outflow tract (LVOT), and at the level of the proximal ascending aorta (AscAO) in subjects from a general population.
DESIGN AND METHOD:250 subjects (43% males, mean age 56 ± 4 years, 42% hypertensives-HT) underwent laboratory examinations, clinic and 24 hours BP measurement, cardiac and carotid ultrasound, carotid-femoral pulse wave velocity measurement (AoPWV).
RESULTS:Aortic diameters were greater HT as compared to NT (Val3.41 ± 0.54 vs 3.25 ± 0.41 cm, LVOT 2.10 ± 0.28 vs 2.04 ± 0.26, AscAo 3.39 ± 0.45 vs 3.18 ± 0.38, all p < 0.05). Aortic diameters were all correlated to clinic and 24 hours BP values. The coefficients of correlation were greater for 24 hours BP (Tab). Val, AscAo, LVOT were also significantly correlated with left ventricular mass (r = 0.61, r = 0.48, and r = 0.43, all p < 0.001), meanmax intima media thickness (r = 0.13, r = 0.24, and r = 0.13, all p < 0.05) and with AoPWV (r = 0.16, p < 0.05, r = 0.28 p < 0.001, r = 0.08 p = ns).(Figure is included in full-text article.)
CONCLUSIONS:The dimensions of the proximal ascending aorta are significantly related to BP values in normotensive subjects and in hypertensive patients. Aortic dimension are more strictly related to twenty-four hours BP values than to clinic BP values. In this sample of general population a significant correlation between aortic dimensions and measures of cardiac and vascular organ damage was also observed, confirming the parallelism between different forms of organ damage
OBJECTIVE:A non-invasive approach for the estimation of mechanical efficiency through the calculation of the ratio between stroke work and HR–pressure product has been recently proposed by de Simone ...et al. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography.The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) in a large general population sample in Northern Italy.
DESIGN AND METHOD:We evaluated 478 subjects participating in a general population study in Northern Italy (Studio Vobarno). All subjects underwent a physical examination with measurement of clinic blood pressure (BP). In all subjects laboratory examinations, 24 hours blood pressure measurement, echocardiography, and assessment of carotid-femoral pulse wave velocity (PWV) were performed.
RESULTS:Subjects had a mean age of 58 ± 10 years, a BMI of 26 ± 4, 44% were males, 69% had arterial hypertension (55% treated). MEEi was lower in males and in patients with increased PWV. MEEi was inversely correlated with age, BMI, waist circumference, clinic and 24 hours BP, glucose, uric acid, triglycerides and directly correlated with HDL. MEEI was also inversely correlated with relative wall thickness (RWT) and PWV. At linear regression multivariate (?) analysis MEEi remained independently related to male gender (β = 0.16, p < 0.001), BMI (β = −0.13, p < 0.005), RWT (β = −0.56, p < 0.001) and PWV (β = −0.10, p < 0.05).
CONCLUSIONS:In a large sample of general population in Northern Italy myocardial mechanoenergetic efficiency was inversely correlated with arterial stiffness, independently of multiple possible confounders.
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