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Lin FC, Chao HS, Chou CW, Tsai HC, Chang SC. Temporal changes in biomarkers in individuals with and without acute mountain sickness following rapid ascent. Am J Med Sci 2023; 365:510-519. [PMID: 36921671 DOI: 10.1016/j.amjms.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 02/13/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Field studies have reported conflicting results regarding changes in biomarkers at high altitude. This study measured temporal changes in biomarkers and compared the differences between individuals with and without acute mountain sickness (AMS). MATERIALS AND METHODS This study included 34 nonacclimatized healthy participants. Ten-milliliters of blood were collected at four time points: 3 days before ascent (T0), on two successive nights at 3150 m (T1 and T2), and 2 days after descent (T3). Participants were transported by bus from 555 m to 3150 m within 3 hours. AMS was diagnosed using the self-reported Lake Louise Scoring (LLS) questionnaire. RESULTS Compared with T0, significant increases in E-selectin and decreases in vascular endothelial growth factor (VEGF) levels were observed at high altitude. Significantly increased C-reactive protein (CRP), monocyte chemoattractant protein-1 (MCP-1), and S100 calcium-binding protein B (S100B) levels were observed at T2, and significantly decreased vascular cell adhesion molecule-1 (VCAM-1) levels were observed at T3. Eighteen (53%) participants developed AMS. Changes in E-selectin, CRP, MCP-1, and S100B levels were independent of AMS. Relative to individuals without AMS, those with AMS had significantly higher atrial natriuretic peptide (ANP) and VCAM-1 levels and lower plasminogen activator inhibitor-1 (PAI-1) levels at T1 and higher brain natriuretic peptide and lower VEGF and PAI-1 levels at T3. LLSs were positively correlated with ANP and VCAM-1 levels and negatively correlated with PAI-1 levels measured at T1. CONCLUSIONS After acute ascent, individuals with and without AMS exhibited different trends in biomarkers associated with endothelial cell activation and natriuretic peptides.
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Affiliation(s)
- Fang-Chi Lin
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Wei Chou
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Han-Chen Tsai
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Dzhalilova D, Makarova O. Differences in Tolerance to Hypoxia: Physiological, Biochemical, and Molecular-Biological Characteristics. Biomedicines 2020; 8:E428. [PMID: 33080959 PMCID: PMC7603118 DOI: 10.3390/biomedicines8100428] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
Hypoxia plays an important role in the development of many infectious, inflammatory, and tumor diseases. The predisposition to such disorders is mostly provided by differences in basic tolerance to oxygen deficiency, which we discuss in this review. Except the direct exposure of different-severity hypoxia in decompression chambers or in highland conditions, there are no alternative methods for determining organism tolerance. Due to the variability of the detection methods, differences in many parameters between tolerant and susceptible organisms are still not well-characterized, but some of them can serve as biomarkers of susceptibility to hypoxia. At the moment, several potential biomarkers in conditions after hypoxic exposure have been identified both in experimental animals and humans. The main potential biomarkers are Hypoxia-Inducible Factor (HIF)-1, Heat-Shock Protein 70 (HSP70), and NO. Due to the different mechanisms of various high-altitude diseases, biomarkers may not be highly specific and universal. Therefore, it is extremely important to conduct research on hypoxia susceptibility biomarkers. Moreover, it is important to develop a method for the evaluation of organisms' basic hypoxia tolerance without the necessity of any oxygen deficiency exposure. This can contribute to new personalized medicine approaches' development for diagnostics and the treatment of inflammatory and tumor diseases, taking into account hypoxia tolerance differences.
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Affiliation(s)
- Dzhuliia Dzhalilova
- Department of Immunomorphology of Inflammation, Federal State Budgetary Institution ‘Research Institute of Human Morphology’, Moscow 117418, Russia;
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Khatri R, Gupta RK, Vats P, Bansal V, Yadav AK, Reddy PK, Bharadwaj A, Chaudhary P, Sharma S, Bajaj AC, Deskit P, Dass D, Baburaj TP, Singh SB, Kumar B. Subclinical elevated B-type Natriuretic Peptide (BNP) indicates endothelial dysfunction contributing to hypoxia susceptibility in healthy individuals. Life Sci 2020; 260:118408. [PMID: 32926931 PMCID: PMC7486215 DOI: 10.1016/j.lfs.2020.118408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
Aims Baseline elevated B-type Natriuretic Peptide (BNP) has been found in high altitude pulmonary edema susceptible population. Exaggerated pulmonary vascular response to hypoxia may be related to endothelial dysfunction in hypoxia susceptible. We hypothesize that baseline BNP levels can predict hypoxia susceptibility in healthy individuals. Main methods The pulmonary vascular response to hypoxia was compared in 35 male healthy individuals divided into two groups based on BNP levels (Group 1 ≤ 15 and Group 2 > 15 pg/ml). Acute normobaric hypoxia was administered to both the groups, to confirm hypoxia susceptibility in Group 2. Key findings Unlike Group 1, Group 2 had elevated post hypoxia BNP levels (26 vs 33.5 pg/ml, p = 0.002) while pulmonary artery pressure was comparable. A negative correlation with tissue oxygen consumption (delta pO2) and compartmental fluid shift was seen in Group 1 only. Endothelial dysfunction in Group 2 resulted in reduced vascular compliance leading to elevation of mean blood pressure on acute hypoxia exposure. BNP showed a positive correlation with endothelial dysfunction in Group 2 and has been linked to pre-diabetic disorder (HbA1c 6 ± 0.44%) and may additionally represent a lower cross-sectional area of vascular bed related to vascular remodeling mediated by chronic hypoxia. Significance Hypoxia susceptibility in healthy individuals may be related to endothelial dysfunction that limits vascular compliance during hypoxic stress. BNP level showed positive correlation with HbA1c (r = 0.49, p = 0.04) and negative correlation with delta pO2 (r = −0.52, p = 0.04) can predict reduced microvascular compliance due to endothelial dysfunction contributing to hypoxia susceptibility in healthy individuals. BNP levels≤15 pg/ml at sea level is indicative of hypoxia resistance.
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Affiliation(s)
- Rahul Khatri
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Rajinder K Gupta
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India.
| | - Praveen Vats
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Vishal Bansal
- Vallabhbhai Patel Chest Institute (VPCI), Delhi University, New Delhi, Delhi 110007, India
| | - Anand Kumar Yadav
- Vallabhbhai Patel Chest Institute (VPCI), Delhi University, New Delhi, Delhi 110007, India
| | - Prasanna K Reddy
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Abhishek Bharadwaj
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Pooja Chaudhary
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Shivani Sharma
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Amir Chand Bajaj
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Padma Deskit
- Sonam Norboo Memorial (S.N.M.) Hospital, Leh-Ladakh, Jammu and Kashmir 194101, India
| | - Deepak Dass
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Thiruthara P Baburaj
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Shashi Bala Singh
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences (DIPAS), Timarpur, Delhi 110054, India
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HILL NEILE, DEIGHTON KEVIN, MATU JAMIE, MISRA SHIVANI, OLIVER NICKS, NEWMAN CARRIE, MELLOR ADRIAN, O’HARA JOHN, WOODS DAVID. Continuous Glucose Monitoring at High Altitude—Effects on Glucose Homeostasis. Med Sci Sports Exerc 2018; 50:1679-1686. [DOI: 10.1249/mss.0000000000001624] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Paul S, Gangwar A, Bhargava K, Khurana P, Ahmad Y. Diagnosis and prophylaxis for high-altitude acclimatization: Adherence to molecular rationale to evade high-altitude illnesses. Life Sci 2018; 203:171-176. [PMID: 29698652 DOI: 10.1016/j.lfs.2018.04.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 04/13/2018] [Accepted: 04/21/2018] [Indexed: 11/25/2022]
Abstract
Lack of zero side-effect, prescription-less prophylactics and diagnostic markers of acclimatization status lead to many suffering from high altitude illnesses. Although not fully translated to the clinical setting, many strategies and interventions are being developed that are aimed at providing an objective and tangible answer regarding the acclimatization status of an individual as well as zero side-effect prophylaxis that is cost-effective and does not require medical supervision. This short review brings together the twin problems associated with high-altitude acclimatization, i.e. acclimatization status and zero side-effect, easy-to-use prophylaxis, for the reader to comprehend as cogs of the same phenomenon. We describe current research aimed at preventing all the high-altitude illnesses by considering them an assault on redox and energy homeostasis at the molecular level. This review also entails some proteins capable of diagnosing either acclimatization or high-altitude illnesses. The future strategies based on bioinformatics and systems biology is also discussed.
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Affiliation(s)
- Subhojit Paul
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi 110054, India
| | - Anamika Gangwar
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi 110054, India
| | - Kalpana Bhargava
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi 110054, India
| | - Pankaj Khurana
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi 110054, India
| | - Yasmin Ahmad
- Peptide & Proteomics Division, Defence Institute of Physiology & Allied Sciences (DIPAS), Defence R&D Organization (DRDO), Timarpur, New Delhi 110054, India.
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Abstract
INTRODUCTION The autonomic system and sympathetic activation appears integral in the pathogenesis of acute mountain sickness (AMS) at high altitude (HA), yet a link between heart rate variability (HRV) and AMS has not been convincingly shown. In this study we investigated the utility of the smartphone-derived HRV score to predict and diagnose AMS at HA. METHODS Twenty-one healthy adults were investigated at baseline at 1400 m and over 10 days during a trek to 5140 m. HRV was recorded using the ithlete HRV device. RESULTS Acute mountain sickness occurred in 11 subjects (52.4%) at >2650 m. HRV inversely correlated with AMS Scores (r = -0.26; 95% CI, -0.38 to -0.13: P < 0.001). HRV significantly fell at 3700, 4100, and 5140 m versus low altitude. HRV scores were lower in those with both mild (69.7 ± 14.0) and severe AMS (67.1 ± 13.1) versus those without AMS (77.5 ± 13.1; effect size n = 0.043: P = 0.007). The HRV score was weakly predictive of severe AMS (AUC 0.74; 95% CI, 0.58-0.89: P = 0.006). The change (delta) in the HRV Score (compared with baseline at 1400 m) was a moderate diagnostic marker of severe AMS (AUC 0.80; 95% CI, 0.70-0.90; P = 0.0004). A fall in the HRV score of >5 had a sensitivity of 83% and specificity of 60% to identify severe AMS (likelihood ratio 1.9). Baseline HRV at 1400 m was not predictive of either AMS at higher altitudes. CONCLUSIONS The ithlete HRV score can be used to help in the identification of severe AMS; however, a baseline score is not predictive of future AMS development at HA.
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Strapazzon G, Pun M, Cappello TD, Procter E, Lochner P, Brugger H, Piccoli A. Total Body Water Dynamics Estimated with Bioelectrical Impedance Vector Analysis and B-Type Natriuretic Peptide After Exposure to Hypobaric Hypoxia: A Field Study. High Alt Med Biol 2017; 18:384-391. [PMID: 29035594 PMCID: PMC5743030 DOI: 10.1089/ham.2017.0056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/07/2017] [Indexed: 01/15/2023] Open
Abstract
Strapazzon, Giacomo, Matiram Pun, Tomas Dal Cappello, Emily Procter, Piergiorgio Lochner, Hermann Brugger, and Antonio Piccoli. Total body water dynamics estimated with bioelectrical impedance vector analysis and B-type natriuretic peptide after exposure to hypobaric hypoxia: A field study. High Alt Med Biol. 18:384-391, 2017.-The relationship between total body water (TBW) dynamics and N-terminal pro-B-type natriuretic peptide (NT-proBNP), a stable metabolite of B-type natriuretic peptide, during acute high altitude exposure is not known. To investigate this, we transported 19 healthy lowland subjects to 3830 m with a helicopter after baseline measurements (262 m). The physiological measurements and clinical assessments were taken at 9, 24, 48, and 72 hours and on the eighth day of altitude exposure. A bioelectrical impedance vector analysis (BIVA) from height corrected Resistance-Reactance (R-Xc graph) was used to estimate TBW status. NT-proBNP was measured from venous blood samples. The changes in impedance vector were lengthened at 9 (p = 0.011), 48 (p = 0.033), and 72 hours (p = 0.015) indicating dehydration compared to baseline. However, there was no dehydration at 24 hours (p > 0.05) from the baseline and the subjects trended to get euhydrated from 9 to 24 hours (p = 0.097). The maximum percent changes in vector length from the baseline were within 10%-15%. There was a significant increase of natural logarithm (ln)(NT-proBNP) after ascent with a peak at 24 hours, although similarly to BIVA values, ln(NT-proBNP) returned to baseline after 8 days of altitude exposure. The changes in impedance vector length were not correlated with the changes in ln(NT-proBNP) (r = -0.101, p = 0.656). In conclusion, the dehydration at high altitude as reflected by 10%-15% vector lengthening falls within "appropriate dehydration" in healthy lowland subjects. NT-proBNP does not simply reflect the TBW status during acute high altitude exposure and needs further investigation.
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Affiliation(s)
| | - Matiram Pun
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
| | | | - Emily Procter
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University Medical Center, Homburg, Germany
| | - Hermann Brugger
- EURAC Institute of Mountain Emergency Medicine, Bolzano, Italy
| | - Antonio Piccoli
- Department of Medicine DIMED, University Hospital of Padova, Padova, Italy
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Mellor A, Bakker-Dyos J, Howard M, Boos C, Cooke M, Vincent E, Scott P, O'Hara J, Clarke SB, Barlow M, Matu J, Deighton K, Hill N, Newman C, Cruttenden R, Holdsworth D, Woods D. The British Services Dhaulagiri Medical Research Expedition 2016: a unique military and civilian research collaboration. J ROY ARMY MED CORPS 2017; 163:371-375. [DOI: 10.1136/jramc-2016-000700] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/17/2016] [Accepted: 01/26/2017] [Indexed: 11/04/2022]
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Anttila K, Streng T, Pispa J, Vainio M, Nikinmaa M. Hypoxia exposure and B-type natriuretic peptide release from Langendorff heart of rats. Acta Physiol (Oxf) 2017; 220:28-35. [PMID: 27496203 PMCID: PMC5412841 DOI: 10.1111/apha.12767] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/04/2016] [Accepted: 08/02/2016] [Indexed: 11/29/2022]
Abstract
Aim We studied whether available oxygen without induced mechanical stretch regulates the release of the biologically active B‐type natriuretic peptide (BNP) from Langendorff heart. Methods Rat hearts were isolated and perfused with a physiological Krebs–Henseleit solution at a constant hydrostatic pressure in Langendorff set‐up. The basal O2 level of perfusate (24.4 ± 0.04 mg L−1) was gradually lowered to 3.0 ± 0.01 mg L−1 over 20 min using N2 gas (n = 7). BNP and O2 level were measured from coronary flow. During control perfusions (n = 5), the O2 concentration was kept at 26.6 ± 0.3 mg L−1. Results A low oxygen concentration in the perfusate was associated with a significant increase in BNP release (F = 40.4, P < 0.001). Heart rate decreased when the oxygen concentration in the perfusate reached 9.1 ± 0.02 mg L−1 and continued to fall in lower oxygen concentrations (F = 14.8, P < 0.001). There was also a significant but inverse correlation between BNP and oxygen in the coronary flow (R2 = 0.27, P < 0.001). Conclusion In the spontaneously beating Langendorff rat heart, a decreasing concentration of oxygen in the ingoing perfusion increased the secretion of BNP. The effect of oxygen was independent of mechanical stretch of the heart as it occurred even when the heart rate decreased but the pressure conditions remained constant. The difference in the oxygen capacitance of blood and Krebs–Henseleit solution appears to be a major factor affecting secretion of BNP, which is correlated with the oxygen tension of myocardial cells and affected both by the oxygen concentration and capacitance of solution perfusing the heart and by the coronary flow.
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Affiliation(s)
- K. Anttila
- Laboratory of Animal Physiology; Department of Biology; University of Turku; Turku Finland
| | - T. Streng
- Laboratory of Animal Physiology; Department of Biology; University of Turku; Turku Finland
- Department of Pharmacology, Drug Development and Therapeutics; University of Turku; Turku Finland
- Turku Center for Disease Modeling (TCDM); University of Turku; Turku Finland
| | - J. Pispa
- Laboratory of Animal Physiology; Department of Biology; University of Turku; Turku Finland
| | - M. Vainio
- Laboratory of Animal Physiology; Department of Biology; University of Turku; Turku Finland
| | - M. Nikinmaa
- Laboratory of Animal Physiology; Department of Biology; University of Turku; Turku Finland
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Woods DR, O'Hara JP, Boos CJ, Hodkinson PD, Tsakirides C, Hill NE, Jose D, Hawkins A, Phillipson K, Hazlerigg A, Arjomandkhah N, Gallagher L, Holdsworth D, Cooke M, Green NDC, Mellor A. Markers of physiological stress during exercise under conditions of normoxia, normobaric hypoxia, hypobaric hypoxia, and genuine high altitude. Eur J Appl Physiol 2017; 117:893-900. [PMID: 28299447 PMCID: PMC5388721 DOI: 10.1007/s00421-017-3573-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/13/2017] [Indexed: 11/29/2022]
Abstract
Purpose To investigate whether there is a differential response at rest and following exercise to conditions of genuine high altitude (GHA), normobaric hypoxia (NH), hypobaric hypoxia (HH), and normobaric normoxia (NN). Method Markers of sympathoadrenal and adrenocortical function [plasma normetanephrine (PNORMET), metanephrine (PMET), cortisol], myocardial injury [highly sensitive cardiac troponin T (hscTnT)], and function [N-terminal brain natriuretic peptide (NT-proBNP)] were evaluated at rest and with exercise under NN, at 3375 m in the Alps (GHA) and at equivalent simulated altitude under NH and HH. Participants cycled for 2 h [15-min warm-up, 105 min at 55% Wmax (maximal workload)] with venous blood samples taken prior (T0), immediately following (T120) and 2-h post-exercise (T240). Results Exercise in the three hypoxic environments produced a similar pattern of response with the only difference between environments being in relation to PNORMET. Exercise in NN only induced a rise in PNORMET and PMET. Conclusion Biochemical markers that reflect sympathoadrenal, adrenocortical, and myocardial responses to physiological stress demonstrate significant differences in the response to exercise under conditions of normoxia versus hypoxia, while NH and HH appear to induce broadly similar responses to GHA and may, therefore, be reasonable surrogates.
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Affiliation(s)
- David Richard Woods
- Royal Centre for Defence Medicine, Birmingham, UK. .,Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK. .,University of Newcastle, Newcastle upon Tyne, UK. .,Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, UK.
| | - John Paul O'Hara
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Christopher John Boos
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,Department of Cardiology, Poole Hospital NHS Foundation Trust, Poole, UK.,Department of Postgraduate Medical Education, Bournemouth University, Poole, UK
| | | | - Costas Tsakirides
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Neil Edward Hill
- Royal Centre for Defence Medicine, Birmingham, UK.,Imperial College London, London, UK.,Charing Cross Hospital, London, UK
| | - Darren Jose
- Pathology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Amanda Hawkins
- Pathology, Poole Hospital NHS Foundation Trust, Poole, UK
| | - Kelly Phillipson
- Department of Biochemistry, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK
| | | | | | - Liam Gallagher
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | | | - Mark Cooke
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | | | - Adrian Mellor
- Royal Centre for Defence Medicine, Birmingham, UK.,Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,James Cook University Hospital, Middlesbrough, TS4 3BW, UK
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Boos CJ, O’Hara JP, Mellor A, Hodkinson PD, Tsakirides C, Reeve N, Gallagher L, Green NDC, Woods DR. A Four-Way Comparison of Cardiac Function with Normobaric Normoxia, Normobaric Hypoxia, Hypobaric Hypoxia and Genuine High Altitude. PLoS One 2016; 11:e0152868. [PMID: 27100313 PMCID: PMC4839767 DOI: 10.1371/journal.pone.0152868] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/21/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND There has been considerable debate as to whether different modalities of simulated hypoxia induce similar cardiac responses. MATERIALS AND METHODS This was a prospective observational study of 14 healthy subjects aged 22-35 years. Echocardiography was performed at rest and at 15 and 120 minutes following two hours exercise under normobaric normoxia (NN) and under similar PiO2 following genuine high altitude (GHA) at 3,375 m, normobaric hypoxia (NH) and hypobaric hypoxia (HH) to simulate the equivalent hypoxic stimulus to GHA. RESULTS All 14 subjects completed the experiment at GHA, 11 at NN, 12 under NH, and 6 under HH. The four groups were similar in age, sex and baseline demographics. At baseline rest right ventricular (RV) systolic pressure (RVSP, p = 0.0002), pulmonary vascular resistance (p = 0.0002) and acute mountain sickness (AMS) scores were higher and the SpO2 lower (p<0.0001) among all three hypoxic groups (GHA, NH and HH) compared with NN. At both 15 minutes and 120 minutes post exercise, AMS scores, Cardiac output, septal S', lateral S', tricuspid S' and A' velocities and RVSP were higher and SpO2 lower with all forms of hypoxia compared with NN. On post-test analysis, among the three hypoxia groups, SpO2 was lower at baseline and 15 minutes post exercise with GHA (89.3±3.4% and 89.3±2.2%) and HH (89.0±3.1 and (89.8±5.0) compared with NH (92.9±1.7 and 93.6±2.5%). The RV Myocardial Performance (Tei) Index and RVSP were significantly higher with HH than NH at 15 and 120 minutes post exercise respectively and tricuspid A' was higher with GHA compared with NH at 15 minutes post exercise. CONCLUSIONS GHA, NH and HH produce similar cardiac adaptations over short duration rest despite lower SpO2 levels with GHA and HH compared with NH. Notable differences emerge following exercise in SpO2, RVSP and RV cardiac function.
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Affiliation(s)
- Christopher John Boos
- Department of Cardiology, Poole Hospital NHS Foundation trust, Poole, United Kingdom
- Dept of Postgraduate Medical Education, Bournemouth University, Bournemouth, United Kingdom
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- * E-mail:
| | - John Paul O’Hara
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - Adrian Mellor
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- James Cook University Hospital, Middlesbrough, TS4 3BW, United Kingdom
- Defence Medical Services, Lichfield, United Kingdom
| | - Peter David Hodkinson
- Defence Medical Services, Lichfield, United Kingdom
- RAF Centre of Aviation Medicine, RAF Henlow, Beds, SG16 6DN, United Kingdom
- Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, United Kingdom
| | - Costas Tsakirides
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - Nicola Reeve
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - Liam Gallagher
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
| | - Nicholas Donald Charles Green
- Defence Medical Services, Lichfield, United Kingdom
- RAF Centre of Aviation Medicine, RAF Henlow, Beds, SG16 6DN, United Kingdom
| | - David Richard Woods
- Research Institute, for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, United Kingdom
- Defence Medical Services, Lichfield, United Kingdom
- Northumbria and Newcastle NHS Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, United Kingdom
- University of Newcastle, Newcastle upon Tyne, United Kingdom
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Shah NM, Hussain S, Cooke M, O’Hara JP, Mellor A. Wilderness medicine at high altitude: recent developments in the field. Open Access J Sports Med 2015; 6:319-28. [PMID: 26445563 PMCID: PMC4590685 DOI: 10.2147/oajsm.s89856] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Travel to high altitude is increasingly popular. With this comes an increased incidence of high-altitude illness and therefore an increased need to improve our strategies to prevent and accurately diagnose these. In this review, we provide a summary of recent advances of relevance to practitioners who may be advising travelers to altitude. Although the Lake Louise Score is now widely used as a diagnostic tool for acute mountain sickness (AMS), increasing evidence questions the validity of doing so, and of considering AMS as a single condition. Biomarkers, such as brain natriuretic peptide, are likely correlating with pulmonary artery systolic pressure, thus potential markers of the development of altitude illness. Established drug treatments include acetazolamide, nifedipine, and dexamethasone. Drugs with a potential to reduce the risk of developing AMS include nitrate supplements, propagators of nitric oxide, and supplemental iron. The role of exercise in the development of altitude illness remains hotly debated, and it appears that the intensity of exercise is more important than the exercise itself. Finally, despite copious studies demonstrating the value of preacclimatization in reducing the risk of altitude illness and improving performance, an optimal protocol to preacclimatize an individual remains elusive.
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Affiliation(s)
- Neeraj M Shah
- Division of Asthma, Allergy and Lung Biology, King’s College London, UK
| | - Sidra Hussain
- School of Medicine, University College London, London, UK
| | - Mark Cooke
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - John P O’Hara
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
| | - Adrian Mellor
- Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK
- Academic Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham, UK
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Mellor A, Boos C, Holdsworth D, Begley J, Hall D, Lumley A, Burnett A, Hawkins A, O'Hara J, Ball S, Woods D. Cardiac biomarkers at high altitude. High Alt Med Biol 2015; 15:452-8. [PMID: 25330333 DOI: 10.1089/ham.2014.1035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Classically, biomarkers such as the natriuretic peptides (NPs) BNP/NT-proBNP are associated with the diagnosis of heart failure and hs-cTnT with acute coronary syndromes. NPs are also elevated in pulmonary hypertension. High pulmonary artery systolic pressure (PASP) is a key feature of high altitude pulmonary edema (HAPE), which may be difficult to diagnose in the field. We have previously demonstrated that NPs are associated with high PASP and the presence of acute mountain sickness (AMS) in a small cohort at HA. We aimed to investigate the utility of several common cardiac biomarkers in diagnosing high PASP and AMS. METHODS 48 participants were assessed post-trekking and at rest at three altitudes: 3833 m, 4450 m, and 5129 m. NPs, hs-cTnT and hsCRP, were quantified using immunoassays, PASP was measured by echocardiography, and AMS scores were recorded. RESULTS Significant changes occurred with ascent in NPs, hs-cTnT, hsCRP (all p<0.001) and PASP (p=0.006). A high PASP (≥40 mm Hg) was associated with higher NPs, NT-proBNP: 137±195 vs. 71.8±68 (p=0.001); BNP 15.3±18.1 vs. 8.7±6.6 (p=0.001). NPs were significantly higher in those with AMS or severe AMS vs. those without (severe AMS: NT-proBNP: 161.2±264 vs. 76.4±82.5 (p=0.008)). The NPs correlated with hsCRP. cTnT increased with exercise at HA and was also higher in those with a high PASP (13.8±21 vs. 7.8±6.5, p=0.018). CONCLUSION The NPs and hs-cTnT are associated with high PASP at HA and the NPs with AMS.
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Affiliation(s)
- Adrian Mellor
- 1 Defence Medical Services , Whittington Barracks, Lichfield, United Kingdom
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Brain Natriuretic Peptide Levels and the Occurrence of Subclinical Pulmonary Edema in Healthy Lowlanders at High Altitude. Can J Cardiol 2015; 31:1025-31. [DOI: 10.1016/j.cjca.2015.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Revised: 03/20/2015] [Accepted: 03/20/2015] [Indexed: 11/19/2022] Open
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Bondke Persson A, Persson PB. Extreme environments. Acta Physiol (Oxf) 2014; 212:189-90. [PMID: 25042108 DOI: 10.1111/apha.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Bondke Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - P. B. Persson
- Institute of Vegetative Physiology; Charité-Universitaetsmedizin Berlin; Berlin Germany
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Heinonen I, Luotolahti M, Vuolteenaho O, Nikinmaa M, Saraste A, Hartiala J, Koskenvuo J, Knuuti J, Arjamaa O. Circulating N-terminal brain natriuretic peptide and cardiac function in response to acute systemic hypoxia in healthy humans. J Transl Med 2014; 12:189. [PMID: 24989366 PMCID: PMC4086279 DOI: 10.1186/1479-5876-12-189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 06/09/2014] [Indexed: 11/22/2022] Open
Abstract
Background As it remains unclear whether hypoxia of cardiomyocytes could trigger the release of brain natriuretic peptide (BNP) in humans, we investigated whether breathing normobaric hypoxic gas mixture increases the circulating NT-proBNP in healthy male subjects. Methods Ten healthy young men (age 29 ± 5 yrs, BMI 24.7 ± 2.8 kg/m2) breathed normobaric hypoxic gas mixture (11% O2/89% N2) for one hour. Venous blood samples were obtained immediately before, during, and 2 and 24 hours after hypoxic exposure. Cardiac function and flow velocity profile in the middle left anterior descending coronary artery (LAD) were measured by Doppler echocardiography. Results Arterial oxygen saturation decreased steadily from baseline value of 99 ± 1% after the initiation hypoxia challenge and reached steady-state level of 73 ± 6% within 20–30 minutes. Cardiac output increased from 6.0 ± 1.2 to 8.1 ± 1.6 L/min and ejection fraction from 67 ± 4% to 75 ± 6% (both p < 0.001). Peak diastolic flow velocity in the LAD increased from 0.16 ± 0.04 to 0.28 ± 0.07 m/s, while its diameter remained unchanged. In the whole study group, NT-proBNP was similar to baseline (60 ± 32 pmol/ml) at all time points. However, at 24 h, concentration of NT-proBNP was higher (34 ± 18%) in five subjects and lower (17 ± 17%), p = 0.002 between the groups) in five subjects than at baseline. Conclusion In conclusion, there is no consistent increase in circulating NT-proBNP in response to breathing severely hypoxic normobaric gas mixture in healthy humans, a possible reason being that the oxygen flux to cardiac myocytes does not decrease because of increased coronary blood flow. However, the divergent individual responses as well as responses in different cardiac diseases warrant further investigations.
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Affiliation(s)
- Ilkka Heinonen
- Turku PET Centre, University of Turku and Turku University Hospital, PO Box 52, FI-20521 Turku, Finland.
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Boos CJ, Holdsworth DA, Hall DP, Mellor A, O'Hara J, Woods DR. Comparison of two methods of assessing total body water at sea level and increasing high altitude. Clin Physiol Funct Imaging 2014; 34:478-84. [DOI: 10.1111/cpf.12121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/02/2013] [Indexed: 11/30/2022]
Affiliation(s)
- C. J. Boos
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Cardiology; Poole Hospital NHS Foundation Trust; Dorset UK
- Centre of Postgraduate Medical Research & Education; Bournemouth University; Bournemouth UK
- Department of Cardiology; Royal Berkshire Hospital; Reading UK
| | - D. A. Holdsworth
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Cardiology; Poole Hospital NHS Foundation Trust; Dorset UK
| | - D. P. Hall
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Anaesthesia; Western General Hospital; Edinburgh UK
| | - A. Mellor
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- James Cook University Hospital; Middlesborough UK
- Leeds Metropolitan University; 104 Carnegie Research Institute (CRI); Leeds UK
| | - J. O'Hara
- Leeds Metropolitan University; 104 Carnegie Research Institute (CRI); Leeds UK
| | - D. R. Woods
- Defence Medical Services; Department of Postgraduate Medicine; Lichfield UK
- Department of Medicine; Royal Victoria Infirmary and Northumbria NHS Foundation Trust; Newcastle upon Tyne UK
- University of Newcastle; Newcastle upon Tyne UK
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Abstract
The military has always had an important role in high altitude research. This is due to the fact that mountainous regions often span borders and provide a safe haven to enemies. Deploying troops rapidly into high altitude environments presents major problems in terms of the development of high altitude illness. This paper examines the rationale for carrying out research at high altitude and the opportunities within the UK Defence Medical Services for carrying out this research.
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Affiliation(s)
- Adrian Mellor
- Defence Medical Services, Lichfield, UK MDHU Northallerton, Friarage Hospital, Northallerton, UK Cardiothoracic Anaesthesia, S Tees NHS Foundation Trust, Middlesbrough, UK Carnegie Institute of Sport, Physical Activity and Leisure, Leeds Metropolitan University, Leeds, UK
| | - D Woods
- Defence Medical Services, Lichfield, UK MDHU Northallerton, Friarage Hospital, Northallerton, UK Royal Victoria Infirmary, Newcastle upon Tyne, UK Carnegie Institute of Sport, Physical Activity and Leisure, Leeds Metropolitan University, Leeds, UK
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The effects of exercise at high altitude on high-sensitivity cardiac troponin release and associated biventricular cardiac function. Clin Res Cardiol 2013; 103:291-9. [DOI: 10.1007/s00392-013-0654-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
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Schmerbach K, Patzak A. Pathophysiological mechanisms in acute mountain sickness. Acta Physiol (Oxf) 2013; 209:246-9. [PMID: 24119164 DOI: 10.1111/apha.12175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- K. Schmerbach
- Institute of Vegetative Physiology; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - A. Patzak
- Institute of Vegetative Physiology; Charité-Universitätsmedizin Berlin; Berlin Germany
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Affiliation(s)
- M. Nikinmaa
- Department of Biology; University of Turku; Turku; Finland
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Woods DR, Mellor A, Begley J, Stacey M, O'Hara J, Hawkins A, Yarker J, Foxen S, Smith C, Boos C. Brain natriuretic peptide and NT-proBNP levels reflect pulmonary artery systolic pressure in trekkers at high altitude. Physiol Res 2013; 62:597-603. [PMID: 23869896 DOI: 10.33549/physiolres.932544] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our objective was to evaluate the utility of the natriuretic peptides BNP (brain natriuretic peptide) and NT-proBNP as markers of pulmonary artery systolic pressure (PASP) in trekkers ascending to high altitude (HA). 20 participants had BNP and NT-proBNP assayed and simultaneous echocardiographic assessment of PASP performed during a trek to 5150 m. PASP increased significantly (p=0.006) with ascent from 24+/-4 to 39+/-11 mm Hg at 5150 m. At 5150 m those with a PASP>/=40 mm Hg (n=8) (versus those with PASP<40 mm Hg) had higher post-exercise BNP (pg/ml): 54.5+/-36 vs. 13.4+/-17 (p=0.012). Their resting BNP at 5150 m was also higher: 57.3+/-43.4 vs. 12.6+/-13 (p=0.017). In those with a pathological (>/=400 pg/ml) rise in NT-proBNP at 5150 m (n=4) PASP was significantly higher: 45.9+/-7.5 vs. 32.2+/-6.2 mm Hg (p=0.015). BNP and NT-proBNP may reflect elevated PASP, a central feature of high altitude pulmonary oedema, at HA.
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Affiliation(s)
- D R Woods
- Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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Gao M, Wang R, Jiayong Z, Liu Y, Sun G. NT-ProBNP levels are moderately increased in acute high-altitude pulmonary edema. Exp Ther Med 2013; 5:1434-1438. [PMID: 23737894 PMCID: PMC3671802 DOI: 10.3892/etm.2013.976] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 01/16/2013] [Indexed: 11/18/2022] Open
Abstract
The aim of the present study was to investigate the effect of B-type natriuretic peptides (BNPs) in acute high-altitude pulmonary edema (HAPE). The study enrolled 46 subjects from lowland Han, including 33 individuals who had acutely ascended to a high altitude (21 individuals with HAPE as the case group and 12 individuals without HAPE as the high-altitude control group) and 13 healthy normal residents as the plain control group. The serum concentrations of N-terminal probrain natriuretic peptide (NT-proBNP), erythropoietin (EPO), vascular endothelial growth factor (VEGF) and nitric oxide (NO) were measured. There were significant differences in the serum concentrations of NT-ProBNP, NO, VEGF and EPO among the three groups. The serum concentrations of NT-ProBNP, EPO and VEGF were significantly higher in the HAPE patients and high-altitude control individuals than those of the plain group. No significant differences were identified between the HAPE patients and the high-altitude control group. In contrast to these three parameters, the serum concentrations of NO in the high-altitude control group were significantly higher than those of the HAPE patients and the plain group, while there were no significant differences in the serum concentrations of NO between the HAPE patients and the plain group. Furthermore, serum concentrations of NT-ProBNP and EPO were significantly reduced following treatment in the HAPE patients, however, no significant changes were identified in VEGF or NO concentrations. BNPs are increased in HAPE with severe hypoxia and right ventricular overload, but are decreased subsequent to treatment. BNPs may therefore be a potential biomarker for the diagnosis and prognosis of HAPE.
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Affiliation(s)
- Mingdong Gao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin 30051
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Sightings edited by John W. Severinghaus. High Alt Med Biol 2012. [DOI: 10.1089/ham.2012.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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