CARTESIAN Study Application Form

Name of Centre *

Institute *

Department *

Unit *

Centre Address *

Centre Address

City

State/Province

Zip/Postal

Country

Forename (of contact person) *

Surname (of contact person) *

Role *

Email *

Phone number *

Is your centre/hospital already contributing to the WHO-ISARIC COVID 19 registry? *

Yes

No

Is your centre/hospital taking care of COVID 19 patients? *

Yes

No

How many patients do you estimate to recruit for this study? *

Other comments

Please indicate below the techniques that are currently performed in your lab and devices available.

Aortic blood pressure *

Yes, which device/devices? Yes, which device/devices?

No

Click Yes for free text box to add details.

Carotid-femoral pulse wave velocity *

Yes - which device/devices? Yes - which device/devices?

No

Carotid ultrasound *

Yes, which device/devices? Yes, which device/devices?

No

Carotid distensibility *

Yes, which device/devices? Yes, which device/devices?

No

Cardiac ultrasound *

Yes, which device/devices? Yes, which device/devices?

No

Flow-mediated dilation *

Yes, which device/devices? Yes, which device/devices?

No

24h-central or peripheral blood pressure *

Yes, which device/devices? Yes, which device/devices?

No

Other vascular ageing measurements