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Chen X, Liu B, Deng Y, Yang F, Wang W, Lin X, Yu L, Pu H, Zhang P, Li Z, Zhong Q, Jia Q, Li Y, Wang X, Chen W, Burkhoff D, He K. Cardiac Adaptation to Prolonged High Altitude Migration Assessed by Speckle Tracking Echocardiography. Front Cardiovasc Med 2022; 9:856749. [PMID: 35677688 PMCID: PMC9167963 DOI: 10.3389/fcvm.2022.856749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Exposure to high altitudes represents physiological stress that leads to significant changes in cardiovascular properties. However, long-term cardiovascular adaptions to high altitude migration of lowlanders have not been described. Accordingly, we measured changes in cardiovascular properties following prolonged hypoxic exposure in acclimatized Han migrants and Tibetans. Methods Echocardiographic features of recently adapted Han migrant (3–12 months, n = 64) and highly adapted Han migrant (5–10 years, n = 71) residence in Tibet (4,300 m) using speckle tracking echocardiography were compared to those of age-matched native Tibetans (n = 75) and Han lowlanders living at 1,400 m (n = 60). Results Short-term acclimatized migrants showed increased estimated pulmonary artery systolic pressure (PASP) (32.6 ± 5.1 mmHg vs. 21.1 ± 4.2 mmHg, p < 0.05), enlarged right ventricles (RVs), and decreased fractional area change (FAC) with decreased RV longitudinal strain (−20 ± 2.8% vs. −25.5 ± 3.9%, p < 0.05). While left ventricular ejection fraction (LVEF) was preserved, LV diameter (41.7 ± 3.1 mm vs. 49.7 ± 4.8 mm, p < 0.05) and LV longitudinal strain (−18.8 ± 3.2% vs. −22.9 ± 3.3%, p < 0.05) decreased. Compared with recent migrants, longer-term migrants had recovered RV structure and functions with slightly improved RV and LV longitudinal strain, though still lower than lowlander controls; LV size remained small with increased mass index (68.3 ± 12.7 vs. 59.3 ± 9.6, p < 0.05). In contrast, native Tibetans had slightly increased PASP (26.1 ± 3.4 mmHg vs. 21.1 ± 4.2 mmHg, p < 0.05) with minimally altered cardiac deformation compared to lowlanders. Conclusion Right ventricular systolic function is impaired in recent (<1 year) migrants to high altitudes but improved during the long-term dwelling. LV remodeling persists in long-term migrants (>5 years) but without impairment of LV systolic or diastolic function. In contrast, cardiac size, structure, and function of native Tibetans are more similar to those of lowland dwelling Hans.
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Affiliation(s)
- Xu Chen
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Bohan Liu
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yujiao Deng
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Feifei Yang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Wenjun Wang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Xixiang Lin
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Liheng Yu
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Haitao Pu
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Peifang Zhang
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Zongren Li
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Qin Zhong
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Jia
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yao Li
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao Wang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Chen
- Department of Ultrasound Diagnosis, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, United States
| | - Kunlun He
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Kunlun He
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Mamazhakypov A, Sartmyrzaeva M, Kushubakova N, Duishobaev M, Maripov A, Sydykov A, Sarybaev A. Right Ventricular Response to Acute Hypoxia Exposure: A Systematic Review. Front Physiol 2022; 12:786954. [PMID: 35095556 PMCID: PMC8791628 DOI: 10.3389/fphys.2021.786954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background: Acute hypoxia exposure is associated with an elevation of pulmonary artery pressure (PAP), resulting in an increased hemodynamic load on the right ventricle (RV). In addition, hypoxia may exert direct effects on the RV. However, the RV responses to such challenges are not fully characterized. The aim of this systematic review was to describe the effects of acute hypoxia on the RV in healthy lowland adults. Methods: We systematically reviewed PubMed and Web of Science and article references from 2005 until May 2021 for prospective studies evaluating echocardiographic RV function and morphology in healthy lowland adults at sea level and upon exposure to simulated altitude or high-altitude. Results: We included 37 studies in this systematic review, 12 of which used simulated altitude and 25 were conducted in high-altitude field conditions. Eligible studies reported at least one of the RV variables, which were all based on transthoracic echocardiography assessing RV systolic and diastolic function and RV morphology. The design of these studies significantly differed in terms of mode of ascent to high-altitude, altitude level, duration of high-altitude stay, and timing of measurements. In the majority of the studies, echocardiographic examinations were performed within the first 10 days of high-altitude induction. Studies also differed widely by selectively reporting only a part of multiple RV parameters. Despite consistent increase in PAP documented in all studies, reports on the changes of RV function and morphology greatly differed between studies. Conclusion: This systematic review revealed that the study reports on the effects of acute hypoxia on the RV are controversial and inconclusive. This may be the result of significantly different study designs, non-compliance with international guidelines on RV function assessment and limited statistical power due to small sample sizes. Moreover, the potential impact of other factors such as gender, age, ethnicity, physical activity, mode of ascent and environmental factors such as temperature and humidity on RV responses to hypoxia remained unexplored. Thus, this comprehensive overview will promote reproducible research with improved study designs and methods for the future large-scale prospective studies, which eventually may provide important insights into the RV response to acute hypoxia exposure.
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Affiliation(s)
- Argen Mamazhakypov
- Department of Internal Medicine, Excellence Cluster Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus Liebig University of Giessen, Giessen, Germany
| | - Meerim Sartmyrzaeva
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Nadira Kushubakova
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Melis Duishobaev
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Abdirashit Maripov
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
| | - Akylbek Sydykov
- Department of Internal Medicine, Excellence Cluster Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Justus Liebig University of Giessen, Giessen, Germany
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Akpay Sarybaev
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
- Kyrgyz Indian Mountain Biomedical Research Center, Bishkek, Kyrgyzstan
- *Correspondence: Akpay Sarybaev
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Mikołajczak K, Czerwińska K, Pilecki W, Poręba R, Gać P, Poręba M. The Impact of Temporary Stay at High Altitude on the Circulatory System. J Clin Med 2021; 10:1622. [PMID: 33921196 PMCID: PMC8068881 DOI: 10.3390/jcm10081622] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/04/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
In recent times many people stay temporarily at high altitudes. It is mainly associated with the growing popularity of regular air travel, as well as temporary trips to mountain regions. Variable environmental conditions, including pressure and temperature changes, have an impact on the human body. This paper analyses the physiological changes that may occur while staying at high altitude in healthy people and in people with cardiovascular diseases, such as arterial hypertension, pulmonary hypertension, heart failure, ischemic heart disease, or arrhythmias. Possible unfavourable changes were underlined. Currently recognized treatment recommendations or possible treatment modifications for patients planning to stay at high altitudes were also discussed.
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Affiliation(s)
- Karolina Mikołajczak
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
| | - Karolina Czerwińska
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland;
| | - Witold Pilecki
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
| | - Rafał Poręba
- Department of Internal and Occupational Diseases, Hypertension and Clinical Oncology, Wroclaw Medical University, Borowska 213, PL 50-556 Wroclaw, Poland;
| | - Paweł Gać
- Department of Hygiene, Wroclaw Medical University, Mikulicza-Radeckiego 7, PL 50-368 Wroclaw, Poland;
| | - Małgorzata Poręba
- Department of Pathophysiology, Wroclaw Medical University, Marcinkowskiego 1, PL 50-368 Wroclaw, Poland; (K.M.); (W.P.); (M.P.)
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