ABSTRACT
BACKGROUND AND AIM: Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. METHODS: We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. RESULTS: We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. CONCLUSIONS: LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.
ABSTRACT
INTRODUCTION: Increased inter-arm systolic blood pressure difference (ΔPsys) has been associated with cardiovascular (CV) disease in elderly patients with CV risk factors. However, its significance in healthy subjects is unclear. AIM: To determine the relationship between ΔPsys, the individual level of physical activity and the global CV risk in apparently healthy adults. METHODS: Systolic blood pressure was measured in both arms in 400 subjects aged 46.5 ± 12.2 years, using a simultaneous oscillometric device (WatchBP Office, Microlife, Widnau, Switzerland). In the subjects with ΔPsys ≥ 10 mmHg (Cases n = 20) and in a Control group (20 subjects without ΔPsys ≥ 10 mmHg), another simultaneous measurement was repeated during a second visit. The physical activity level was assessed via the International Physical Activity Questionnaire-Short Form (IPAQ-SF), the ankle brachial pressure index (ABPI) with a photoplethysmographic method (Angioflow-Microlab, Padova, Italy) and the CV risk via the Framingham Risk Score (FRS). RESULTS: The prevalence of ΔPsys ≥ 10 mmHg in the whole population was 5% (95% CI 3.24-8.01%). Cases and Controls were comparable in gender, age, and BMI. ΔPsys ≥ 10 mmHg was only confirmed in 17.6% of the Cases. No statistically significant differences were found between groups for IPAQ-SF, ABPI, or FRS. CONCLUSIONS: The prevalence of ΔPsys ≥ 10 mmHg in this population was only slightly lower than what observed in older, hypertensive or diabetic patients. Cases and Controls did not differ in physical activity level, ankle brachial pressure index and CV risk. However, low test-retest reliability might limit the use of ΔPsys as a reliable marker for CV screening in this population.
