Aims
Myocardial injury is frequently observed in patients hospitalized with coronavirus disease 2019 (COVID‐19) pneumonia. Different cardiac abnormalities have been reported during the acute COVID‐19 ...phase, ranging from infra‐clinic elevations of myocardial necrosis biomarkers to acute cardiac dysfunction and myocarditis. There is limited information on late cardiac sequelae in patients who have recovered from acute COVID‐19 illness. We aimed to document the presence and quantify the extent of myocardial functional alterations in patients hospitalized 6 months earlier for COVID‐19 infection.
Methods and results
We conducted a prospective echocardiographic evaluation of 48 patients (mean age 58 ± 13 years, 69% male) hospitalized 6 ± 1 month earlier for a laboratory‐confirmed and symptomatic COVID‐19. Thirty‐two (66.6%) had pre‐existing cardiovascular risks factors (systemic hypertension, diabetes, or dyslipidaemia), and three patients (6.2%) had a known prior myocardial infarction. Sixteen patients (33.3%) experienced myocardial injury during the index COVID‐19 hospitalization as identified by a rise in cardiac troponin levels. Six months later, 60.4% of patients still reported clinical symptoms including exercise dyspnoea for 56%. Echocardiographic measurements under resting conditions were not different between patients with versus without myocardial injury during the acute COVID‐19 phase. In contrast, low‐level exercise (25W for 3 min) induced a significant increase in the average E/e′ ratio (10.1 ± 4.3 vs. 7.3 ± 11.5, P = 0.01) and the systolic pulmonary artery pressure (33.4 ± 7.8 vs. 25.6 ± 5.3 mmHg, P = 0.02) in patients with myocardial injury during the acute COVID‐19 phase. Sensitivity analyses showed that these alterations of left ventricular diastolic markers were observed regardless of whether of cardiovascular risk factors or established cardiac diseases indicating SARS‐CoV‐2 infection as a primary cause.
Conclusions
Six months after the acute COVID‐19 phase, significant cardiac diastolic abnormalities are observed in patients who experienced myocardial injury but not in patients without cardiac involvement.
High blood pressure is the number one killer in the world. About 1.5 billion people suffered from hypertension in 2010, and these numbers are increasing year by year. The basics of the management of ...high blood pressure are described in the Canadian, American, International and European guidelines for hypertension. However, there are similarities and differences in the definition, measurement and management of blood pressure between these different guidelines. According to the Canadian guidelines, normal blood pressure is less than 140/90 mmHg (systolic blood pressure/diastolic blood pressure). The AHA and ESC estimate normal blood pressure to be less than 120/80 mmHg (systolic blood pressure/diastolic blood pressure). Regarding treatments, the AHA, ISH and ESC are also in agreement about dual therapy as the first-line therapy, while Canadian recommendations retain the idea of monotherapy as the initiation of treatment. When it comes to measuring blood pressure, the four entities agree on the stratification of intervention in absolute cardiovascular risk.
Background
In patients with Vascular Ehlers-Danlos syndrome (vEDS), an abnormally low carotid intima-media thickness (CIMT) may increase the risk of arterial dissection and rupture. Thus its accurate ...assessment by ultra–high frequency ultrasound (UHFUS), thanks to its higher spatial resolution, may be clinically relevant.
Aim
To assess the feasibility and reproducibility of carotid parameters, assessed by UHFUS in vESD patients, and to evaluate the agreement with the gold standard technique, echotracking by radiofrequency.
Methods
16 vEDS patients were recruited (6 women, 40 ± 11 years, BP 115 ± 6/62 ± 6 mmHg). Common carotid parameters were assessed by echotracking (Esaote, Artlab software) and UHFUS (VevoMD, Visualsonics; CVSuite software, Quipu srl), to evaluate agreement. The coefficient of variation between two consecutive clips was computed. The results were compared to those of 16 age-, sex- and BP-matched healthy individuals.
Results
In all 16 patients the acquisition and automated analysis of carotid clips was feasible. Correlation between echotracking and UHFUS was satisfactory (diameter
r
= 0.63,
p
= 0.001; CIMT
r
= 0.65,
p
= 0.006; distension
r
= 0.84,
p
< 0.001). Bland-Altman plots showed a good agreement between the two techniques, with a non significant bias either for diameter 110 μm (−184; 404) or CIMT 27 μm (−10; 75). Intra-operator coefficient of variation was 3.26% (diameter), 7.11% (CIMT) and 5.65% (distension). vEDS patients had reduced CIMT (419 ± 85 vs 522 ± 97 μm,
p
= 0.004) and distension (453 ± 150 vs 613 ± 176 μm,
p
= 0.01) than controls and tended to have a reduced diameter (6558 ± 525 vs 6945 ± 653 μm,
p
= 0.08), while carotid-femoral pulse wave velocity was similar (7.38 ± 1.08 vs 7.46 ± 1.396 m/s,
p
= 0.78).
Conclusion
UHFUS is feasible, accurate and reproducible for the evaluation of carotid parameters in vEDS.
The vascular system is subject to continual variation in mechanical stresses, both physiological and pathological. Vascular remodeling via changes in vessel wall properties, including thickness and ...stiffness, is a major feature of aging and cardiovascular disease.
A more detailed understanding of the interplay between mechanical stress, aging, CVD and vascular remodeling will aid prevention of increased cardiovascular risk following long term microgravity.
This study aims at assessing vascular remodeling processes resulting from a 60-day head-down-tilt bed-rest period during the European Space Agency Study (Toulouse, France).
We hypothesize that arterial remodeling processes are modified by long term bed- rest and constitute a significant cardiovascular risk in the long term for astronauts. Applanation tonometry is used to assess carotid to femoral pulse wave velocity (PWV) and non-invasive ultrasound imaging are used to assess arterial remodelling processes at the carotid, femoral, brachial and popliteal arteries.Measurements are performed at baseline; at day 29 and 52 of bed-rest; and at day 6 and 30 of the recovery period.
The preliminary results including 10 first subjects, demonstrate a strong effect of bed- rest on arterial PWV.The average PWV at baseline equals 7,6 ± 1.4m/s and is increased to 9.0 ± 1.9m/s after 29 days, and, 9.3 ± 1.8m/s after 52 days bed-rest. This increase is significantly different between baseline, and, 29 and 52 days bed-rest (p < 0.005).
Increase in PWV suggests a rapid and significant stiffening of the central arteries, which on healthy subjects corresponds to an aging process wich occurs many years. Low gravity conditions as during bed-rest induce significant arterial stiffening that could be linked to long term CVD risks for either patients in bed-rest or astronauts.
Patients with chronic severe psoriasis are at increased cardiovascular risk (CVR). Modern systemic treatments of psoriasis involve anti-TNF alpha (ATNF) and more recently introduced anti-IL12/IL-23 ...(ustekinumab, AIL12/23) which, by interfering with IL-17, a possibly vasculoprotective cytokine, may increase CVR. We characterized large arteries remodeling and stiffness during longitudinal follow-up under ATNF and AIL12/23.
We included 31 patients. Followed-up was 13 ± 3 months with a mean number of 3 visits. Patients were treated either by ATNF (n = 13) or by AIL12/23 (n = 18). Mean age was 49 (27–71) 50% were females, 89% were overweight, 55% smokers and 32% (well controlled) hypertensives. Patients did not differ for severity scores of psoriasis or baseline characteristics. Carotid to femoral pulse wave velocity (PWV) and central pressure (applanation tonometry), carotid PWV and IMT (echotracking) were measured at each visit.
Blood pressure and heart rate did not change with either treatment. Carotid diameter did not change during follow-up, IMT increased more with AIL12/23 than in ATNF group (diff. à 18 months 75 µm, p = 0.10). Carotid distension and carotid distensibility decreased significantly under AIL12/23, whereas it increased with ATNF, independently of BP. Carotid PWV and CF-PWV increased independently of BP with AIL12-23 and decreased with ATNF (18 months diff. +1.60 m/s and +1.15 m/s, p < 0.05, respectively).
We documented an increased in stiffness and hypertrophy of large arteries during longitudinal follow-up of patients under antiinterleukin 12/23 treatment for psoriasis, compared to antiTNFalpha. Whether this is due to a protective effect of ATNF and/or adverse effect of AIL12-23 remains to be determined.
Arterial stiffness may influence the contour of the peripheral pulse, suggesting that contour analysis of the digital volume pulse (DVP) might be used to estimate peripheral blood pressure and a ...stiffness index (SI).
The objective is to establish a transfer function that estimates the peripheral blood pressure using the PPG pulse, calibrated with a brachial pressure cuff, and then to deduce a stiffness index using the established parameters. We positioned the photodiode sensor on the finger. Brachial blood pressure measurement was performed with a cuff adapted to the arm circumference and an oscillometric device (Omron M10 -IT). Pulse wave velocity (PWV) measurements were performed with the pOpmètre® system. DVP waveforms were recorded over a 10 s period and ensemble-averaged to obtain a single waveform from which DT (DVP) was determined as the time between the first systolic peak and the early diastolic peak/inflection point in the waveform. The SI is the ratio of the subject’s height to the DT (DVP).
69 subjects were included: 24 healthy subjects and 45 patients with essential hypertension. The correlation between the estimated peripheral diastolic pressure and the brachial one was good and significant (r
2
= 0.51; p < 0.001). A better correlation was found in terms of peripheral systolic pressure (r
2
= 0.56; p < 0.001). The correlation between the SI and the ft-PWV was significant (r = 0.5; p < 0.001) classifying the estimation as good agreement. The estimation of the peripheral blood pressure and a stiffness index with the PPG signal qualifies as good agreement with the reference technique.
Purpose
There is a need for new tools to screen large populations for cardiovascular disease risk. The CARDIS consortium (European Union H2020 funding) developed an easy-to-use, non-contact device ...for measuring carotid to femoral pulse wave velocity (cfPWV). It consists in a laser doppler vibrometer (LDV), which measures skin vibrations induced by large artery pulses. Pulse waveforms can be tracked and transit time (TT) can be calculated. This study aimed at comparing LDV-cfPWV with the reference cfPWV measured by applanation tonometry (Sphygmocor).
Methods
We included 100 patients with mild to stage 3 hypertension, controlled or not. Reflective tapes were applied on the carotid and femoral arteries to measure LDV-cfPWV 4 times. TT was measured by the foot-to-foot method from the maximum of 2nd derivative using in-house algorithms not requiring ECG, and compared to Sphygmocor (3 acquisitions).
Results
LDV-cfPWV was obtained in 100% of patients. Mean age was 47 ± 19 (range 19–85). Hypertensives were well controlled (119/65 mmHg). Mean value of LDV-cfPWV was 6.9 ± 1.7 m/s, compared to 7.5 ± 1.7 m/s with Sphygmocor, bias 0.65 ± 1.27, R value 0.72 (Figure 1), which qualifies agreement as acceptable according to the guidelines from the ARTERY Society
1
. Reproducibility was good with a median coefficient of variation of 5.6%. LDV-cfPWV showed similar associations with age and blood pressure than tonometry (
r
= 0.68,
p
< 0.001 and
r
= 0.44,
p
< 0.001, respectively).
Conclusion
Non-contact measurement of pulse wave velocity by laser doppler vibrometry is feasible, fast and easy to perform, and provides acceptable agreement with reference technique.
Figure 1
Background/Objectives
The baroreflex is a crucial mechanism acutely modulating vascular tone and heart rate response to maintain blood pressure (BP) in an optimal range. A decrease in baroreflex ...sensitivity (BRS) is associated with ageing, and pathological conditions such as hypertension and diabetes. Antihypertensive agents are generally known to have beneficial effect on the BRS, however it is still uncertain if the effect is mediated through a more compliant arterial wall or a sympathoinhibitory action.
Methods
In the Paris Prospective Study III
1
, spontaneous baroreflex, carotid stiffness and pharmacological drugs intake were available in 7967 adults (aged 55–75 years). The neural component of the baroreflex sensitivity (nBRS) was obtained with a cross-spectral analysis of variations in carotid distention rate and R-R intervals. Pharmacological classes were analysed according to the Anatomical Therapeutic Chemical (ATC) classification. Individuals with a BP lowering medication (BP-treated) were paired to non-BP treated individuals with a similar cardiovascular risk (controls) using a propensity score matching procedure
(n =
1182 pairs).
Results
Amongst pharmacological classes of BP lowering agents, only agents acting on the renin-angiotensin system (ACEi-ARB) were associated with nBRS
(β =
−0.08,
p =
0.045). Compared to their matched controls, ACEi-ARB users had lower nBRS (2.79 ± 0.66 vs. 2.90 ± 0.62,
p =
0.03). In multivariate analysis, ACEi-ARB remained significant (std
β
= −0.09,
p =
0.025) after adjustment for carotid stiffness (std
β
= 0.25,
p <
0.001) and systolic pressure (std
β
= −0.20,
p <
0.001).
Conclusion
In this epidemiological study, ACEi-ARB were negatively associated with nBRS. This effect is independent of BP and stiffness, which may suggest an inhibition of sympathetic activity by ACEi-ARB.
Rationale and Aim
This study is aimed at identifying possible patterns of vascular wall disarray and remodeling in radial arteries of patients with fibromuscular dysplasia (FMD), by means of ...ultrahigh frequency ultrasound (UHFUS).
Methods
UHFUS scans of the radial arteries and of 30 FMD patients and 30 healthy controls were obtained by VevoMD (70 MHz probe, FUJIFILM, VisualSonics, Toronto, Canada). 10 end-diastolic frames for each subject were analyzed. 74 radiomic features and 4 engineered parameters were extracted: intima-media thickness (IMT) and adventitia thickness (AT), an adjunctive acoustic interface for each layer (IMT and AT triple signal). The extracted parameters were used to train classification models, using Support Vector Machine Linear (SVM), K-Nearest Neighbors (KNN), Logistic Regression, Linear Discriminant Analysis (LDA). The models were then tested on an independent validation population (38 FMD patients and 28 healthy subjects).
Results
IMT (185 ± 46 vs 168 ± 37,
p
=) and AT (104 ± 34 vs 96 ± 35,
p
= 0.004) were significantly higher in FMD than in controls. IMT and AT triple signal were also more frequent in FMD than in control images (
p
< for both). The most accurate classification models were LDA (sensitivity = 0.67, specificity = 0.76, accuracy = 0.71, AUC = 0.71) and Logistic Regression (sensitivity = 0.71, specificity = 0.72, accuracy = 0.71, AUC = 0.71). The models showed and accuracy of about 70% when tested on the validation population.
Conclusions
Wall ultrastructure of radial arteries of FMD patients is extensively altered: IMT and AT are thickened and the first and/or second layer of the arterial wall is splitted, showing a triple signal feature. Radiomic descriptors combined with engineered parameters allow to distinguish between radial images from FMD patients and controls with a 70% accuracy.
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