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Liu Z, Yang J, Yang B, Sun M, Ye X, Yu S, Tan H, Hu M, Lv H, Wu B, Gao X, Huang L. Effect of ubiquinol on electrophysiology during high-altitude acclimatization and de-acclimatization: A substudy of the Shigatse CARdiorespiratory fitness (SCARF) randomized clinical trial. Int J Cardiol 2024; 401:131817. [PMID: 38307422 DOI: 10.1016/j.ijcard.2024.131817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND High-altitude exposure changes the electrical conduction of the heart. However, reports on electrocardiogram (ECG) characteristics and potent prophylactic agents during high-altitude acclimatization and de-acclimatization are inadequate. This study aimed to investigate the effects of ubiquinol on electrophysiology after high-altitude hypoxia and reoxygenation. METHODS The study was a prospective, randomized, double-blind, placebo-controlled trial. Forty-one participants were randomly divided into two groups receiving ubiquinol 200 mg daily or placebo orally 14 days before flying to high altitude (3900 m) until the end of the study. Cardiopulmonary exercise testing was performed at baseline (300 m), on the third day after reaching high altitude, and on the seventh day after returning to baseline. RESULTS Acute high-altitude exposure prolonged resting ventricular repolarization, represented by increased corrected QT interval (455.9 ± 23.4 vs. 427.1 ± 19.1 ms, P < 0.001) and corrected Tpeak-Tend interval (155.5 ± 27.4 vs. 125.3 ± 21.1 ms, P < 0.001), which recovered after returning to low altitude. Ubiquinol supplementation shortened the hypoxia-induced extended Tpeak-Tend interval (-7.7 ms, [95% confidence interval (CI), -13.8 to -1.6], P = 0.014), Tpeak-Tend /QT interval (-0.014 [95% CI, -0.027 to -0.002], P = 0.028), and reserved maximal heart rate (11.9 bpm [95% CI, 3.2 to 20.6], P = 0.013) during exercise at high altitude. Furthermore, the decreased resting amplitude of the ST-segment in the V3 lead was correlated with decreased peak oxygen pulse (R = 0.713, P < 0.001) and maximum oxygen consumption (R = 0.595, P < 0.001). CONCLUSIONS Our results illustrated the electrophysiology changes during high-altitude acclimatization and de-acclimatization. Similarly, ubiquinol supplementation shortened the prolonged Tpeak-Tend interval and reserved maximal heart rate during exercise at high altitude. REGISTRATION URL: www.chictr.org.cn; Unique identifier: ChiCTR2200059900.
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Affiliation(s)
- Zhen Liu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Jie Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Bingjie Yang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Mengjia Sun
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Xiaowei Ye
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Shiyong Yu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Hu Tan
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Mingdong Hu
- Department of Physical Examination, the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hailin Lv
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Boji Wu
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Xubin Gao
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China
| | - Lan Huang
- Institute of Cardiovascular Diseases of PLA, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China; Department of Cardiology, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, PR China.
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Fejes R, Szűcsborus T, Czombos A, Góg C, Ruzsa Z. Managing Patients With Concurrent High Risk for Bleeding and Thromboembolic Events. Cureus 2024; 16:e53557. [PMID: 38445160 PMCID: PMC10913840 DOI: 10.7759/cureus.53557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2024] [Indexed: 03/07/2024] Open
Abstract
The number of patients with high bleeding risk (HBR) and high thromboembolic risk (HTR) is increasing. Gastrointestinal bleeding (GIH), acute coronary syndrome (ACS), and pulmonary embolism (PE) are representative conditions due to HBR/HTR. Although these disorders are located at opposite ends of the same disease spectrum, this does not mean a patient with HBR cannot have a concomitant HTR. The clinical manifestation of these two risks mostly results in critically ill patients for whom management means a huge challenge. We have numerous well-structured guidelines about treating GIH, ACS, or PE, but the literature and recommendations about the concomitant onset of these diseases are limited. Expert recommendations suggest an integrative, comprehensive assessment of patient and intervention-related factors to decide on the antithrombotic regimen with the best clinical benefit by assessing thrombotic and bleeding risks. In general, if thrombotic factors predominate, a longer duration, more aggressive antithrombotic regimen should be planned, and if bleeding susceptibility is higher, a shorter duration, de-escalated regimen should be pursued. In this study, we aimed to explore the clinical dilemmas involved by presenting two cases with delicate management.
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Affiliation(s)
- Roland Fejes
- Department of Internal Medicine, Healthcare Centre of Hódmezővásárhely-Makó, Makó, HUN
| | - Tamás Szűcsborus
- Division of Invasive Cardiology, University of Szeged, Szeged, HUN
| | - András Czombos
- Department of Internal Medicine, Healthcare Centre of Hódmezővásárhely-Makó, Makó, HUN
| | - Csaba Góg
- Department of Internal Medicine, Healthcare Centre of Hódmezővásárhely-Makó, Makó, HUN
| | - Zoltán Ruzsa
- Division of Invasive Cardiology, University of Szeged, Szeged, HUN
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Richalet JP, Hermand E, Lhuissier FJ. Cardiovascular physiology and pathophysiology at high altitude. Nat Rev Cardiol 2024; 21:75-88. [PMID: 37783743 DOI: 10.1038/s41569-023-00924-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/04/2023]
Abstract
Oxygen is vital for cellular metabolism; therefore, the hypoxic conditions encountered at high altitude affect all physiological functions. Acute hypoxia activates the adrenergic system and induces tachycardia, whereas hypoxic pulmonary vasoconstriction increases pulmonary artery pressure. After a few days of exposure to low oxygen concentrations, the autonomic nervous system adapts and tachycardia decreases, thereby protecting the myocardium against high energy consumption. Permanent exposure to high altitude induces erythropoiesis, which if excessive can be deleterious and lead to chronic mountain sickness, often associated with pulmonary hypertension and heart failure. Genetic factors might account for the variable prevalence of chronic mountain sickness, depending on the population and geographical region. Cardiovascular adaptations to hypoxia provide a remarkable model of the regulation of oxygen availability at the cellular and systemic levels. Rapid exposure to high altitude can have adverse effects in patients with cardiovascular diseases. However, intermittent, moderate hypoxia might be useful in the management of some cardiovascular disorders, such as coronary heart disease and heart failure. The aim of this Review is to help physicians to understand the cardiovascular responses to hypoxia and to outline some recommendations that they can give to patients with cardiovascular disease who wish to travel to high-altitude destinations.
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Affiliation(s)
- Jean-Paul Richalet
- Hypoxie et Poumon, Université Sorbonne Paris Nord, INSERM U1272, Paris, France.
| | - Eric Hermand
- Unité de Recherche Pluridisciplinaire Sport Santé Société, ULR 7369-URePSSS, Université Littoral Côte d'Opale, Université Artois, Université Lille, CHU Lille, Dunkirk, France
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Jia N, Shen Z, Zhao S, Wang Y, Pei C, Huang D, Wang X, Wu Y, Shi S, He Y, Wang Z. Eleutheroside E from pre-treatment of Acanthopanax senticosus (Rupr.etMaxim.) Harms ameliorates high-altitude-induced heart injury by regulating NLRP3 inflammasome-mediated pyroptosis via NLRP3/caspase-1 pathway. Int Immunopharmacol 2023; 121:110423. [PMID: 37331291 DOI: 10.1016/j.intimp.2023.110423] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
Eleutheroside E, a major natural bioactive compound in Acanthopanax senticosus (Rupr.etMaxim.) Harms, possesses anti-oxidative, anti-fatigue, anti-inflammatory, anti-bacterial and immunoregulatory effects. High-altitude hypobaric hypoxia affects blood flow and oxygen utilisation, resulting in severe heart injury that cannot be reversed, thereby eventually causing or exacerbating high-altitude heart disease and heart failure. The purpose of this study was to determine the cardioprotective effects of eleutheroside E against high-altitude-induced heart injury (HAHI), and to study the mechanisms by which this happens. A hypobaric hypoxia chamber was used in the study to simulate hypobaric hypoxia at the high altitude of 6000 m. 42 male rats were randomly assigned to 6 equal groups and pre-treated with saline, eleutheroside E 100 mg/kg, eleutheroside E 50 mg/kg, or nigericin 4 mg/kg. Eleutheroside E exhibited significant dose-dependent effects on a rat model of HAHI by suppressing inflammation and pyroptosis. Eleutheroside E downregulated the expressions of brain natriuretic peptide (BNP), creatine kinase isoenzymes (CK-MB) and lactic dehydrogenase (LDH). Moreover, The ECG also showed eleutheroside E improved the changes in QT interval, corrected QT interval, QRS interval and heart rate. Eleutheroside E remarkably suppressed the expressions of NLRP3/caspase-1-related proteins and pro-inflammatory factors in heart tissue of the model rats. Nigericin, known as an agonist of NLRP3 inflammasome-mediated pyroptosis, reversed the effects of eleutheroside E. Eleutheroside E prevented HAHI and inhibited inflammation and pyroptosis via the NLRP3/caspase-1 signalling pathway. Taken together, eleutheroside E is a prospective, effective, safe and inexpensive agent that can be used to treat HAHI.
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Affiliation(s)
- Nan Jia
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Zherui Shen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Sijing Zhao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Yilan Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Caixia Pei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Demei Huang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Xiaomin Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Yongcan Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Shihua Shi
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China
| | - Yacong He
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China.
| | - Zhenxing Wang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan 611137, China.
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A systematic review of electrocardiographic changes in populations temporarily ascending to high altitudes. Curr Probl Cardiol 2023; 48:101630. [PMID: 36731688 DOI: 10.1016/j.cpcardiol.2023.101630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
High altitudes can cause hypobaric hypoxia, altering human physiology and the corresponding electrocardiogram (ECG). As part of the Altitude Nondifferentiated ECG Study (ANDES), this paper reviews ECG changes in subjects ascending to high altitudes. This review was conducted following PRISMA guidelines. PubMed, EMBASE, OVID Medline, and Web of Science were searched. 19 studies were ultimately included. Notable ECG changes at high altitudes include T wave inversion in the precordial leads and rightward QRS axis deviation in leads I, II and aVF. Less common findings were increases in P wave amplitude, QRS amplitude, and QTc interval. These ECG deviations typically self-resolved within 2-6 weeks following return to sea level. Consideration must be taken when interpreting ECG changes in individuals during ascent to, at, or upon return from high altitudes. Further large-scale studies are needed to elucidate temporal and altitude-dependent ECG patterns and establish reference standards for clinicians.
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Shimamoto Y, Sanuki M, Kurita S, Ueki M, Kuwahara Y. Two-handed facemask technique effectively causes hyperventilation in electroconvulsive therapy: an observational study. BMC Anesthesiol 2022; 22:376. [PMID: 36471246 PMCID: PMC9720916 DOI: 10.1186/s12871-022-01928-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Electroconvulsive therapy (ECT) remains the mainstay treatment option for patients with psychiatric diseases, such as severe depression. Although various anesthetic techniques provide adequate therapeutic seizures, hyperventilation is a useful adjunct to augment seizure duration and improve seizure quality. We investigated how to efficiently use a facemask to accomplish protocolized hyperventilation and evaluate its effect on ECT seizure. METHODS We studied 60 patients aged ≥18 years who underwent ECT. The patients were divided into two groups according to the technique of facemask ventilation used: the one-handed (n = 30) and two-handed (n = 30) groups. Following anesthesia induction under preoxygenation conditions, hyperventilation induced hypocapnia in the one-handed facemask group with manual bag ventilation was compared to that in the two-handed facemask group with assisted pressure-controlled ventilation. Ictal and peri-ictal electroencephalogram parameters and cardiovascular responses were monitored and compared between the one-handed and two-handed groups. RESULTS The two-handed technique demonstrated better electroencephalogram regularity and minimized cardiovascular stress compared to the one-handed technique. These conclusions come from the fact that the one-handed technique induced a substantial volume of leaks around the facemask (201.7 ± 98.6 mL/breath), whereas minimal leaks (25.8 ± 44.6 mL/breath) with stabler and higher ventilation rate led to greater inhaled minute ventilation in the two-handed group (the one-handed group, 9.52 ± 3.94 L/min; the two-handed group, 11.95 ± 2.29 L/min; p < 0.005). At the end of ECT treatment, all parameters of blood pressure and heart rate increased significantly in both groups equally, with lower SpO2 and more ST-segment depression on the electrocardiogram in the one-handed group. Comparing baseline values before anesthesia, ECT treatment significantly depressed ST-segment in both groups, while the degree of depression in ST-segment increased significantly in the one-handed group compared to that in the two-handed group. CONCLUSIONS End-tidal carbon dioxide monitoring for hyperventilation can reliably ensure hypocapnia only in the two-handed group. In ECT, the two-handed technique assisted by pressure-controlled ventilation is an effective and practical method for hyperventilation to induce adequate therapeutic seizures. While, the two-handed group with sufficient preoxygenation did not cause more cardiovascular stress than the one-handed group. TRIAL REGISTRATION UMIN Clinical Trials Registry 000046544, Date of registration 05/01/2022.
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Affiliation(s)
- Yoko Shimamoto
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Michiyoshi Sanuki
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Shigeaki Kurita
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Masaya Ueki
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
| | - Yoshie Kuwahara
- grid.440118.80000 0004 0569 3483Department of Anesthesiology, NHO Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima, Japan
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但 晴, 白 婧, 蔡 钟, 林 琨, 李 泱. [Changes of myocardial calcium currents in rats with myocardial injury induced by running exercise during acute hypoxia]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1359-1366. [PMID: 36210709 PMCID: PMC9550543 DOI: 10.12122/j.issn.1673-4254.2022.09.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the changes in myocardial calcium currents in rats subjected to forced running exercise during acute hypoxia and their association with myocardial injury. METHODS Forty SD rats were randomized into quiescent group and running group either in normal oxygen (NQ and NR groups, respectively) or in acute hypoxia (HQ and HR groups, respectively). Hypoxia was induced by keeping the rats in a hypobaric oxygen chamber (PaO2=61.6kpa) for 4 h a day; the rats in the two running groups were forced to run on running wheels for 4 h each day. Rat ventricular myocytes was isolated by enzymatic digestion for recording action potentials and currents using patch clamp technique, and confocal Ca2+ imaging was used to monitor intracellular Ca2+ levels. The expressions of Cav1.2 channel and the cardiac ryanodine receptor (RyR2) were determined using Western blotting. RESULTS Compared with those in NQ group, the rats in HR group showed significantly decreased SOD activity (P < 0.01), increased h-FABP, hs-CRP and IMA levels (P < 0.05 or 0.01), obvious myocardial pathology, and prolonged APD50 and APD90 (P < 0.05). Of the different stress conditions, forced running in acute hypoxia resulted in the most prominent increase of the densities of ICa, L currents, causing also a significant left shift of the steady state activation curve and a significant right shift of the steady state inactivation curve. Compared with those in NQ group, the rats in NR, HQ and HR groups all exhibited higher rates of spontaneous calcium wave events in the cardiac myocytes, increased frequency of calcium sparks with lowered amplitude, enhanced calcium release amplitude in the ventricular myocytes, and delayed calcium ion reabsorption; in particular, these changes were the most conspicuous in HR group (P < 0.05 or 0.01). There was also a significant increase in the protein levels of Cav1.2 channel and RyR2 receptor in HR group (P < 0.05 or 0.01). CONCLUSIONS The mechanism of myocardial injury in rats subjected to forced running in acute hypoxia may involve the increase of oxidative stress and calcium current and intracellular calcium overload.
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Affiliation(s)
- 晴 但
- 解放军总医院第一医学中心心血管内科,北京 100039Department of Cardiology, Fist Medical Center, Chinese PLA General Hospital, Beijing 100000, China
| | - 婧 白
- 郑州大学第一附属医院心血管内科,河南 郑州 450052Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - 钟奇 蔡
- 中国人民解放军南部战区总医院干部病房,广东 广州 510014Cadre's Ward, General Hospital of Southern Theater Command of PLA, Guangzhou 510000, China
| | - 琨 林
- 解放军总医院第一医学中心心血管内科,北京 100039Department of Cardiology, Fist Medical Center, Chinese PLA General Hospital, Beijing 100000, China
| | - 泱 李
- 解放军总医院第六医学中心心血管 病医学部,北京 100048Department of Cardiology, Sixth Medical Center, Chinese PLA General Hospital, Beijing 100048, China
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Wei CY, Chen PN, Lin SS, Huang TW, Sun LC, Tseng CW, Lin KF. Using machine learning to determine the correlation between physiological and environmental parameters and the induction of acute mountain sickness. BMC Bioinformatics 2022; 22:628. [PMID: 35641924 PMCID: PMC9153088 DOI: 10.1186/s12859-022-04749-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Recent studies on acute mountain sickness (AMS) have used fixed-location and fixed-time measurements of environmental and physiological variable to determine the influence of AMS-associated factors in the human body. This study aims to measure, in real time, environmental conditions and physiological variables of participants in high-altitude regions to develop an AMS risk evaluation model to forecast prospective development of AMS so its onset can be prevented.
Results Thirty-two participants were recruited, namely 25 men and 7 women, and they hiked from Cuifeng Mountain Forest Park parking lot (altitude: 2300 m) to Wuling (altitude: 3275 m). Regression and classification machine learning analyses were performed on physiological and environmental data, and Lake Louise Acute Mountain Sickness Scores (LLS) to establish an algorithm for AMS risk analysis. The individual R2 coefficients of determination between the LLS and the measured altitude, ambient temperature, atmospheric pressure, relative humidity, climbing speed, heart rate, blood oxygen saturation (SpO2), heart rate variability (HRV), were 0.1, 0.23, 0, 0.24, 0, 0.24, 0.27, and 0.35 respectively; incorporating all aforementioned variables, the R2 coefficient is 0.62. The bagged trees classifier achieved favorable classification results, yielding a model sensitivity, specificity, accuracy, and area under receiver operating characteristic curve of 0.999, 0.994, 0.998, and 1, respectively.
Conclusion The experiment results indicate the use of machine learning multivariate analysis have higher AMS prediction accuracies than analyses utilizing single varieties. The developed AMS evaluation model can serve as a reference for the future development of wearable devices capable of providing timely warnings of AMS risks to hikers.
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Affiliation(s)
- Chih-Yuan Wei
- Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan
| | - Ping-Nan Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan. .,Department of Biomedical Engineering, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan.
| | - Shih-Sung Lin
- Department of Computer Science and Information Engineering, Chinese Culture University, No.55, Hwa-Kang Road, Yang-Ming-Shan, Taipei, 11114, Taiwan
| | - Tsai-Wang Huang
- Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei, 11490, Taiwan
| | - Ling-Chun Sun
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan
| | - Chun-Wei Tseng
- School of Medicine, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan
| | - Ke-Feng Lin
- Medical Informatics Office, Tri‑Service General Hospital, National Defense Medical Center, No.325, Sec. 2, Chenggong Rd., Neihu Dist., Taipei, 11490, Taiwan.,School of Public Health, National Defense Medical Center, No.161, Sec. 6, Minquan E. Rd., Neihu Dist., Taipei, 11490, Taiwan
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Sinamaw D, Getnet M, Abdulkadir M, Abebaw K, Ebrahim M, Diress M, Akalu Y, Ambelu A, Dagnew B. Patterns and associated factors of electrocardiographic abnormality among type 2 diabetic patients in Amhara National Regional State Referral Hospitals, Ethiopia: a multicenter institution-based cross-sectional study. BMC Cardiovasc Disord 2022; 22:230. [PMID: 35590246 PMCID: PMC9118567 DOI: 10.1186/s12872-022-02661-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the most causes of mortality and morbidity among diabetes mellitus (DM) patients. Electrocardiographic (ECG) changes are common in the early course of the disease. Little is known about the electrocardiographic abnormalities among type 2 DM patients in Ethiopia. This study determined the overall prevalence, its patterns, and the associated factors of ECG abnormalities among people living with T2DM in Amhara National Regional State referral hospitals, Ethiopia. METHODS A multicenter institution-based cross-sectional study was conducted from 01 April to 30 May 2021. A simple random sampling and systematic sampling techniques were employed to select the referral hospitals and study participants, respectively. A digital electrocardiograph was used to measure the ECG parameters and the other data were collected using an interviewer-administered questionnaire. Epi-data version-4.6 and Stata-14 were used for data entry and statistical analysis, respectively. The descriptive statistics were presented with tables and graphs. A binary logistic regression model was fitted to identify associated factors of ECG abnormality. In the final model, statistical significance was decided at p≤0.05, and the strength of association was indicated using an adjusted odds ratio with 95% CI. RESULTS Two-hundred and fifty-eight participants (response rate = 99.6%) were included for the analysis. The prevalence of overall ECG abnormality was 45% (95% CI: 39, 51%). On the basis of the electrocardiographic patterns, 57 (21.1%; 95% CI: 14.6, 32.6%) were presented with T-wave abnormality, 36 (14%; 95% CI: 10.1, 18.8%) left axis deviation, and 24 (9.3% [6.3, 13.5%]) sinus tachycardia. Higher monthly income (> 90$) (AOR = 0.51 [0.31, 0.83]), over 10 years duration of DM (AOR = 4.5[1.05, 18.94]), hypertension (AOR = 3.9 [1.6, 9.40]), fasting blood sugar of ≥ 130 mg/dl (AOR = 5.01[2.13, 12.20]), and overweight (AOR = 2.65[1.17, 5.98]) were statistically significant factors of overall ECG abnormality. CONCLUSIONS Nearly, half of the participants had at least one ECG abnormality. Higher-income, prolonged disease duration, hypertension, higher fasting blood sugar, and overweight were significantly associated with ECG abnormality. The findings of this study suggest the need to institute routine ECG screening for all T2DM patients to reduce ECG abnormalities and further complications.
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Affiliation(s)
- Deresse Sinamaw
- Department of Biomedical Science, School of Medicine, College of Medicine and Health Sciences, Debre Markos University, P. O. Box 269, Debre Markos, Ethiopia
| | - Mihret Getnet
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Mohamed Abdulkadir
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Kassa Abebaw
- Department of Biomedical Science, School of Medicine, College of Medicine and Health Sciences, Debre Markos University, P. O. Box 269, Debre Markos, Ethiopia
| | - Mohammed Ebrahim
- Department of Biomedical Science, School of Medicine, College of Medicine and Health Sciences, Meda Welabu University, P. O. Box 247, Meda Welabu, Ethiopia
| | - Mengistie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Yonas Akalu
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Adugnaw Ambelu
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
| | - Baye Dagnew
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia
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10
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Jiang S, Fan F, Yang L, Chen K, Sun Z, Zhang Y, Cairang N, Wang X, Meng X. Salidroside attenuates high altitude hypobaric hypoxia-induced brain injury in mice via inhibiting NF-κB/NLRP3 pathway. Eur J Pharmacol 2022; 925:175015. [PMID: 35561751 DOI: 10.1016/j.ejphar.2022.175015] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 04/21/2022] [Accepted: 05/04/2022] [Indexed: 12/18/2022]
Abstract
Salidroside (Sal), an active ingredient from Rhodiola crenulate, has been reported to exert neuroprotection in cerebral injury from hypobaric hypoxia (HH) at high altitude. However, it remains to be understood whether its protective effects are related to inflammation suppression. In the present work, we aimed to reveal the mechanism of Sal attenuating HH-induced brain injury in mice caused by an animal hypobaric and hypoxic chamber. Our results provided that Sal could attenuate HH-evoked pathological injury and oxidative stress response by decreasing the content of ROS and MDA, and elevating the activities of SOD and GSH-Px. Sal treatment could partly enhance the energy metabolism, evidenced by increasing the activities of Na+-K+-ATPase, Ca2+-Mg2+-ATPase, ATP, SDH, HK and PK, while decreasing the release of LDH and LD. Meanwhile, Sal administration reversed the degradation of tight junction proteins ZO-1, Occludin and Claudin-5. Further, the increased levels of TNF-α, IL-1β and IL-6 were confined with Sal administration under the HH condition. Importantly, Sal could downregulate the proteins expression of p-NF-κB-p65, NLRP3, cleaved-Caspase-1 and ASC. Sal also decreased the protein expression of iNOS and COX2 with the increased CD206 and Arg1 expression. Taken together, these data provided that the inhibited NF-κB/NLRP3 pathway by Sal could attenuate HH-induced cerebral oxidative stress injury, inflammatory responses and the blood brain barrier (BBB) damage, attributing to the improved energy metabolism and the microglial phenotype of anti-inflammatory M2. The findings suggested that Sal was expected to be a promising anti-inflammatory agent for high altitude HH-induced brain injury.
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Affiliation(s)
- Shengnan Jiang
- School of Pharmacy, and Research Institute of Integrated TCM & Western Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Fangfang Fan
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Lu Yang
- School of Pharmacy, and Research Institute of Integrated TCM & Western Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Ke Chen
- School of Pharmacy, and Research Institute of Integrated TCM & Western Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Zhihao Sun
- School of Basic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Yi Zhang
- School of Ethnic Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China; Ethnic Medicine Academic Heritage Innovation Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Nanjia Cairang
- University of Tibetan Medicine, Lasa, Tibet, 850000, China.
| | - Xiaobo Wang
- School of Pharmacy, and Research Institute of Integrated TCM & Western Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China; State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China.
| | - Xianli Meng
- School of Pharmacy, and Research Institute of Integrated TCM & Western Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China; State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China.
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11
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Georges T, Menu P, Le Blanc C, Ferreol S, Dauty M, Fouasson-Chailloux A. Contribution of Hypoxic Exercise Testing to Predict High-Altitude Pathology: A Systematic Review. Life (Basel) 2022; 12:life12030377. [PMID: 35330129 PMCID: PMC8950822 DOI: 10.3390/life12030377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/20/2022] Open
Abstract
Altitude travelers are exposed to high-altitude pathologies, which can be potentially serious. Individual susceptibility varies widely and this makes it difficult to predict who will develop these complications. The assessment of physiological adaptations to exercise performed in hypoxia has been proposed to help predict altitude sickness. The purpose of this review is to evaluate the contribution of hypoxic exercise testing, achieved in normobaric conditions, in the prediction of severe high-altitude pathology. We performed a systematic review using the databases PubMed, Science Direct and Embase in October 2021 to collect studies reporting physiological adaptations under hypoxic exercise testing and its interest in predicting high-altitude pathology. Eight studies were eligible, concerning 3558 patients with a mean age of 46.9 years old, and a simulated mean altitude reaching of 5092 m. 597 patients presented an acute mountain sickness during their altitude travels. Three different protocols of hypoxic exercise testing were used. Acute mountain sickness was defined using Hackett’s score or the Lake Louise score. Ventilatory and cardiac responses to hypoxia, desaturation in hypoxia, cerebral oxygenation, core temperature, variation in body mass index and some perceived sensations were the highlighted variables associated with acute mountain sickness. A decision algorithm based on hypoxic exercise tests was proposed by one team. Hypoxic exercise testing provides promising information to help predict altitude complications. Its interest should be confirmed by different teams.
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Affiliation(s)
- Thomas Georges
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (T.G.); (P.M.); (C.L.B.); (S.F.); (M.D.)
| | - Pierre Menu
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (T.G.); (P.M.); (C.L.B.); (S.F.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Institut Régional de Médecine du Sport (IRMS), 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France
| | - Camille Le Blanc
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (T.G.); (P.M.); (C.L.B.); (S.F.); (M.D.)
| | - Sophie Ferreol
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (T.G.); (P.M.); (C.L.B.); (S.F.); (M.D.)
| | - Marc Dauty
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (T.G.); (P.M.); (C.L.B.); (S.F.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Institut Régional de Médecine du Sport (IRMS), 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France
| | - Alban Fouasson-Chailloux
- CHU Nantes, Service de Médecine Physique et Réadapatation Locomotrice et Respiratoire, 44093 Nantes, France; (T.G.); (P.M.); (C.L.B.); (S.F.); (M.D.)
- CHU Nantes, Service de Médecine du Sport, 44093 Nantes, France
- Institut Régional de Médecine du Sport (IRMS), 44093 Nantes, France
- Inserm, UMR 1229, RMeS, Regenerative Medicine and Skeleton, Université de Nantes, ONIRIS, F-44042 Nantes, France
- Correspondence:
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12
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Wong AKI, Charpignon M, Kim H, Josef C, de Hond AAH, Fojas JJ, Tabaie A, Liu X, Mireles-Cabodevila E, Carvalho L, Kamaleswaran R, Madushani RWMA, Adhikari L, Holder AL, Steyerberg EW, Buchman TG, Lough ME, Celi LA. Analysis of Discrepancies Between Pulse Oximetry and Arterial Oxygen Saturation Measurements by Race and Ethnicity and Association With Organ Dysfunction and Mortality. JAMA Netw Open 2021; 4:e2131674. [PMID: 34730820 PMCID: PMC9178439 DOI: 10.1001/jamanetworkopen.2021.31674] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Discrepancies in oxygen saturation measured by pulse oximetry (Spo2), when compared with arterial oxygen saturation (Sao2) measured by arterial blood gas (ABG), may differentially affect patients according to race and ethnicity. However, the association of these disparities with health outcomes is unknown. OBJECTIVE To examine racial and ethnic discrepancies between Sao2 and Spo2 measures and their associations with clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS This multicenter, retrospective, cross-sectional study included 3 publicly available electronic health record (EHR) databases (ie, the Electronic Intensive Care Unit-Clinical Research Database and Medical Information Mart for Intensive Care III and IV) as well as Emory Healthcare (2014-2021) and Grady Memorial (2014-2020) databases, spanning 215 hospitals and 382 ICUs. From 141 600 hospital encounters with recorded ABG measurements, 87 971 participants with first ABG measurements and an Spo2 of at least 88% within 5 minutes before the ABG test were included. EXPOSURES Patients with hidden hypoxemia (ie, Spo2 ≥88% but Sao2 <88%). MAIN OUTCOMES AND MEASURES Outcomes, stratified by race and ethnicity, were Sao2 for each Spo2, hidden hypoxemia prevalence, initial demographic characteristics (age, sex), clinical outcomes (in-hospital mortality, length of stay), organ dysfunction by scores (Sequential Organ Failure Assessment [SOFA]), and laboratory values (lactate and creatinine levels) before and 24 hours after the ABG measurement. RESULTS The first Spo2-Sao2 pairs from 87 971 patient encounters (27 713 [42.9%] women; mean [SE] age, 62.2 [17.0] years; 1919 [2.3%] Asian patients; 26 032 [29.6%] Black patients; 2397 [2.7%] Hispanic patients, and 57 632 [65.5%] White patients) were analyzed, with 4859 (5.5%) having hidden hypoxemia. Hidden hypoxemia was observed in all subgroups with varying incidence (Black: 1785 [6.8%]; Hispanic: 160 [6.0%]; Asian: 92 [4.8%]; White: 2822 [4.9%]) and was associated with greater organ dysfunction 24 hours after the ABG measurement, as evidenced by higher mean (SE) SOFA scores (7.2 [0.1] vs 6.29 [0.02]) and higher in-hospital mortality (eg, among Black patients: 369 [21.1%] vs 3557 [15.0%]; P < .001). Furthermore, patients with hidden hypoxemia had higher mean (SE) lactate levels before (3.15 [0.09] mg/dL vs 2.66 [0.02] mg/dL) and 24 hours after (2.83 [0.14] mg/dL vs 2.27 [0.02] mg/dL) the ABG test, with less lactate clearance (-0.54 [0.12] mg/dL vs -0.79 [0.03] mg/dL). CONCLUSIONS AND RELEVANCE In this study, there was greater variability in oxygen saturation levels for a given Spo2 level in patients who self-identified as Black, followed by Hispanic, Asian, and White. Patients with and without hidden hypoxemia were demographically and clinically similar at baseline ABG measurement by SOFA scores, but those with hidden hypoxemia subsequently experienced higher organ dysfunction scores and higher in-hospital mortality.
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Affiliation(s)
- An-Kwok Ian Wong
- Division of Pulmonary, Allergy, Critical Care,
and Sleep Medicine, Emory University, Atlanta, Georgia
- Division of Pulmonary, Allergy, and Critical
Care Medicine, Duke University, Durham, North Carolina
| | - Marie Charpignon
- MIT Institute for Data, Systems and Society,
Cambridge, Massachusetts
| | - Han Kim
- Department of Biomedical Engineering, Johns
Hopkins University, Baltimore, Maryland
| | | | - Anne A. H. de Hond
- Leiden University Medical Centre, Department of
Biomedical Data Sciences, Leiden, the Netherlands
- Leiden University Medical Centre, Department of
Information Technology and Digital Innovation, Leiden, the Netherlands
| | - Jhalique Jane Fojas
- Department of Neurology, Beth Israel Deaconess
Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Azade Tabaie
- Department of Biomedical Informatics, Emory
University, Atlanta, Georgia
| | - Xiaoli Liu
- School of Biological Science and Medical
Engineering, Beihang University, Beijing, China
| | | | - Leandro Carvalho
- Respiratory Institute, Cleveland Clinic,
Cleveland, Ohio
- Sociedade Mineira de Terapia Intensiva, Belo
Horizonte, Brazil
| | | | | | - Lasith Adhikari
- Connected Care and Personal Health, Philips
Research North America, Cambridge, Massachusetts
| | - Andre L. Holder
- Division of Pulmonary, Allergy, Critical Care,
and Sleep Medicine, Emory University, Atlanta, Georgia
| | - Ewout W. Steyerberg
- Leiden University Medical Centre, Department of
Biomedical Data Sciences, Leiden, the Netherlands
| | | | - Mary E. Lough
- Medicine–Primary Care and Population
Health, Stanford University, California
- Office of Research, Stanford Health Care,
Stanford, California
| | - Leo Anthony Celi
- Massachusetts Institute of Technology,
Laboratory for Computational Physiology, Cambridge
- Division of Pulmonary, Critical Care, and
Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan
School of Public Health, Boston, Massachusetts
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13
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Ivonina NI, Fokin AA, Roshchevskaya IM. Body Surface Potential Mapping During Heart Ventricular Repolarization in Male Swimmers and Untrained Persons Under Hypoxic and Hypercapnic Hypoxia. High Alt Med Biol 2021; 22:308-316. [PMID: 34314614 DOI: 10.1089/ham.2020.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Ivonina, Natalya I., Andrey A. Fokin, and Irina M. Roshchevskaya. Body surface potential mapping during heart ventricular repolarization in male swimmers and untrained persons under hypoxic and hypercapnic hypoxia. High Alt Med Biol. 00:000-000, 2021. Background: In swimmers, as a result of prolonged breath-holding during swimming, first hypoxic hypoxia (HH) and then hypercapnic hypoxia (HCH) occurs, which may influence the electrical activity of the heart (EAH). What type of normobaric hypoxia more strongly affects the EAH-normocapnic HH or HCH? Methods: The electrical activity of swimmers' hearts (n = 7) and untrained persons (n = 10) was studied by using electrocardiography (ECG) and body surface potential mapping (BSPM) during the period of ventricular repolarization at baseline, at normocapnic HH, at HCH, and in the recovery period. Results: HH led to more significant changes in the EAH in all participants in comparison with HCH. There was no change in the amplitude of T waveECG at hypoxic and HCH, but a change in the amplitude of the minimum was noted in BSPM. The minimum in athletes changed by the end of the exposure (from -0.40 ± 0.12 mV to -0.26 ± 0.11 mV, p = 0.001); in the control, it decreased earlier (after 8 minutes of exposure to HH, the amplitude of the minimum was -0.24 ± 0.08 mV, p = 0.026). With HH, the duration of the QT interval in athletes was shortened due to the shortening of the J-Tpeak (from 250 to 188 ms, p = 0.001) and the Tpeak-Tend (from 98 to 86 ms) intervals. In controls, the decrease in the QT interval was due to the J-Tpeak shortening only (from 280 to 200 ms, p = 0.026). Conclusions: In the study of the effect of hypoxia on the EAH during ventricular repolarization, the use of the BSPM has proven to be more informative than the use of traditional ECG. When using potential mapping, more significant changes in ventricular repolarization at HH than at HCH were revealed, whereas the parameters changed less in swimmers compared with the baseline than in controls during both exposures.
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Affiliation(s)
- Natalya I Ivonina
- Department of Comparative Cardiology of the Federal Research Centre "Komi Science Centre of the Ural Branch of the Russian Academy of Sciences," Syktyvkar, Russian Federation
| | - Andrey A Fokin
- Department of Comparative Cardiology of the Federal Research Centre "Komi Science Centre of the Ural Branch of the Russian Academy of Sciences," Syktyvkar, Russian Federation
| | - Irina M Roshchevskaya
- Federal State Budgetary Institution "Research Zakusov Institute of Pharmacology," Moscow, Russian Federation
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14
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Richalet JP, Pillard F, LE Moal D, Rivière D, Oriol P, Poussel M, Chenuel B, Doutreleau S, Vergès S, Demanez S, Vergnion M, Boulet JM, Douard H, Dupré M, Mesland O, Remetter R, Lonsdorfer-Wolf E, Frey A, Vilcoq L, Nedelec Jaffuel A, Debeaumont D, Duperrex G, Lecoq F, Hédon C, Hayot M, Giardini G, Lhuissier FJ. Validation of a Score for the Detection of Subjects with High Risk for Severe High-Altitude Illness. Med Sci Sports Exerc 2021; 53:1294-1302. [PMID: 33433150 DOI: 10.1249/mss.0000000000002586] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE A decision tree based on a clinicophysiological score (severe high-altitude illness (SHAI) score) has been developed to detect subjects susceptible to SHAI. We aimed to validate this decision tree, to rationalize the prescription of acetazolamide (ACZ), and to specify the rule for a progressive acclimatization. METHODS Data were obtained from 641 subjects in 15 European medical centers before and during a sojourn at high altitude. Depending on the value of the SHAI score, advice was given and ACZ was eventually prescribed. The outcome was the occurrence of SHAI at high altitude as a function of the SHAI score, ACZ prescription, and use and fulfillment of the acclimatization rule. RESULTS The occurrence of SHAI was 22.6%, similar to what was observed 18 yr before (23.7%), whereas life-threatening forms of SHAI (high-altitude pulmonary and cerebral edema) were less frequent (2.6%-0.8%, P = 0.007). The negative predictive value of the decision tree based was 81%, suggesting that the procedure is efficient to detect subjects who will not suffer from SHAI, therefore limiting the use of ACZ. The maximal daily altitude gain that limits the occurrence of SHAI was established at 400 m. The occurrence of SHAI was reduced from 27% to 12% when the recommendations for ACZ use and 400-m daily altitude gain were respected (P < 0.001). CONCLUSIONS This multicenter study confirmed the interest of the SHAI score in predicting the individual risk for SHAI. The conditions for an optimized acclimatization (400-m rule) were also specified, and we proposed a rational decision tree for the prescription of ACZ, adapted to each individual tolerance to hypoxia.
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Affiliation(s)
| | - Fabien Pillard
- Université Paul Sabatier III, Faculté de Médecine Purpan, UMR INSERM U1048 Institut des maladies métaboliques et cardiovasculaires, Hôpital Pierre Paul Riquet, Unité de Médecine du Sport, Toulouse, FRANCE
| | - David LE Moal
- Université Sorbonne Paris Nord, UMR INSERM 1272 Hypoxie et poumon, Bobigny, FRANCE
| | - Daniel Rivière
- Université Paul Sabatier III, Faculté de Médecine Purpan, UMR INSERM U1048 Institut des maladies métaboliques et cardiovasculaires, Hôpital Pierre Paul Riquet, Unité de Médecine du Sport, Toulouse, FRANCE
| | - Philippe Oriol
- Institut Régional de Médecine et d'Ingénierie de Sport, Médecine du sport et Myologie, CHU Saint-Etienne, Saint-Etienne, FRANCE
| | - Mathias Poussel
- Centre Hospitalier Régional Universitaire de Nancy, Centre Universitaire de Médecine du Sport et Activité Physique Adaptée, Service des Explorations de la Fonction Respiratoire, Université de Lorraine, EA 3450 Développement, Adaptation et Handicap, Nancy, FRANCE
| | - Bruno Chenuel
- Centre Hospitalier Régional Universitaire de Nancy, Centre Universitaire de Médecine du Sport et Activité Physique Adaptée, Service des Explorations de la Fonction Respiratoire, Université de Lorraine, EA 3450 Développement, Adaptation et Handicap, Nancy, FRANCE
| | | | | | - Sophie Demanez
- Centre de physiologie de l'effort-CB Move Herve-Julémont, BELGIUM
| | - Michel Vergnion
- Centre de physiologie de l'effort-CB Move Herve-Julémont, BELGIUM
| | - Jean-Michel Boulet
- Hôpital cardiologique, Service maladies coronaires, tests d'effort et readaptation, Pessac, FRANCE
| | - Hervé Douard
- Hôpital cardiologique, Service maladies coronaires, tests d'effort et readaptation, Pessac, FRANCE
| | - Maryse Dupré
- Institut Régional de Médecine du Sport, CHU Nantes, PHU 10, Hôpital Saint Jacques, Nantes, FRANCE
| | - Olivier Mesland
- Institut Régional de Médecine du Sport, CHU Nantes, PHU 10, Hôpital Saint Jacques, Nantes, FRANCE
| | - Romain Remetter
- Centre Hospitalier Universitaire de Strasbourg, Service de Physiologie et EFR, Nouvel Hôpital Civil, Strasbourg, FRANCE
| | - Evelyne Lonsdorfer-Wolf
- Centre Hospitalier Universitaire de Strasbourg, Service de Physiologie et EFR, Nouvel Hôpital Civil, Strasbourg, FRANCE
| | - Alain Frey
- Centre Hospitalier Intercommunal Poissy/Saint-Germain, Service Médecine du Sport, Site Saint Germain, Saint-Germain en Laye, FRANCE
| | - Louis Vilcoq
- Centre Hospitalier Intercommunal Poissy/Saint-Germain, Service Médecine du Sport, Site Saint Germain, Saint-Germain en Laye, FRANCE
| | - Anne Nedelec Jaffuel
- Centre Hospitalier Intercommunal Poissy/Saint-Germain, Service Médecine du Sport, Site Saint Germain, Saint-Germain en Laye, FRANCE
| | - David Debeaumont
- Centre Hospitalo-Universitaire de Rouen, Hôpital Charles Nicolle, CIC-CRB 1404, Unité de physiologie respiratoire et de l'exercice, Rouen, FRANCE
| | - Guy Duperrex
- Hôpitaux du Pays du Mont Blanc, Consultation de Médecine et Traumatologie du Sport, Montagne, Sallanches, FRANCE
| | - François Lecoq
- Hôpitaux du Pays du Mont Blanc, Consultation de Médecine et Traumatologie du Sport, Montagne, Sallanches, FRANCE
| | - Christophe Hédon
- UMR INSERM U1046-CNRS 9214-PhyMedExp, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, FRANCE
| | - Maurice Hayot
- UMR INSERM U1046-CNRS 9214-PhyMedExp, Université de Montpellier, CHU Arnaud de Villeneuve, Montpellier, FRANCE
| | - Guido Giardini
- Ospedale U. Parini-Azienda USL della Valle d'Aosta, Centro di Medicina e Neurologia di Montagna, Aosta, ITALY
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15
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Li Y, Li J, Liu J, Xue Y, Cao Z, Liu C. Variations of Time Irreversibility of Heart Rate Variability Under Normobaric Hypoxic Exposure. Front Physiol 2021; 12:607356. [PMID: 33746767 PMCID: PMC7973363 DOI: 10.3389/fphys.2021.607356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
In the field of biomedicine, time irreversibility is used to describe how imbalanced and asymmetric biological signals are. As an important feature of signals, the direction of time is always ignored. To find out the variation regularity of time irreversibility of heart rate variability (HRV) in the initial stage of hypoxic exposure, the present study implemented 2 h acute normobaric hypoxic exposure on six young subjects who have no plateau or hypoxia experiences; oxygen concentration was set as 12.9%. Electrocardiogram (ECG) signals were recorded in the whole process and RR interval sequences were extracted. Mathematical operations were executed to transform the difference of adjacent RR intervals into proportion and distance with delay time to conduct time irreversibility analysis of HRV. The same calculating method was implemented on six items randomly picked out from the MIT-BIH normal sinus rhythm database as a control group. Results show that variation of time irreversibility of HRV in a hypoxic environment is different from that in a normoxic environment, time irreversibility indices of a hypoxic group decreases continually at a delay time of 1 and 2, and indices curves of time irreversibility gradually tend to be steady and gather with each other at a delay time of 3 or 4. The control group shows no consistent tendency no matter what the delay time is in the range of 1-4. Our study indicates that in short-time hypoxic exposure, as hypoxic time goes by, regulation of the cardiovascular autonomic nervous system weakens; regulation times and intensity of sympathetic and parasympathetic nerves tend to be equal.
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Affiliation(s)
- Yang Li
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Jianqing Li
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Jian Liu
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Yong Xue
- Air Force Medical Center, Beijing, China
| | | | - Chengyu Liu
- School of Instrument Science and Engineering, Southeast University, Nanjing, China
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16
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Busch SA, van Diepen S, Roberts R, Steele AR, Berthelsen LF, Smorschok MP, Bourgoin C, Steinback CD. Short-term hypoxia does not promote arrhythmia during voluntary apnea. Physiol Rep 2021; 9:e14703. [PMID: 33426815 PMCID: PMC7797307 DOI: 10.14814/phy2.14703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 12/19/2022] Open
Abstract
The presence of bradycardic arrhythmias during volitional apnea at altitude may be caused by chemoreflex activation/sensitization. We investigated whether bradyarrhythmic episodes became prevalent in apnea following short‐term hypoxia exposure. Electrocardiograms (ECG; lead II) were collected from 22 low‐altitude residents (F = 12; age=25 ± 5 years) at 671 m. Participants were exposed to normobaric hypoxia (Spo2 ~79 ± 3%) over a 5‐h period. ECG rhythms were assessed during both free‐breathing and maximal volitional end‐expiratory and end‐inspiratory apnea at baseline during normoxia and hypoxia exposure (20 min [AHX]; 5 h [HX5]). Free‐breathing HR became elevated at AHX (78 ± 10 bpm; p < 0.0001) and HX5 (80 ± 12 bpm; p < 0.0001) compared to normoxia (68 ± 10 bpm), whereas apnea caused significant bradycardia at AHX (nadir end‐expiratory −17 ± 14 bpm; p < 0.001) and HX5 (nadir end‐expiratory −19 ± 15 bpm; p < 0.001), but not during normoxia (nadir end‐expiratory −4 ± 13 bpm), with no difference in bradycardia responses between apneas at AHX and HX5. Conduction abnormalities were noted in five participants during normoxia (Premature Ventricular Contraction, Sinus Pause, Junctional Rhythm, Atrial Foci), which remained unchanged during apnea at AHX and HX5 (Premature Ventricular Contraction, Premature Atrial Contraction, Sinus Pause). End‐inspiratory apneas were overall longer across conditions (normoxia p < 0.05; AHX p < 0.01; HX5 p < 0.001), with comparable HR responses to end‐expiratory and fewer occurrences of arrhythmia. While short‐term hypoxia is sufficient to elicit bradycardia during apnea, the occurrence of arrhythmias in response to apnea was not affected. These findings indicate that previously observed bradyarrhythmic events in untrained individuals at altitude only become prevalent following chronic hypoxia specificlly.
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Affiliation(s)
- Stephen A Busch
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Sean van Diepen
- Department of Critical Care and Divison of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Richard Roberts
- Department of Physiology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew R Steele
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Lindsey F Berthelsen
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Megan P Smorschok
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Cody Bourgoin
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
| | - Craig D Steinback
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada
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Surgical Mask Use in Physical Ecercise in Young Healthy Subjects Sume Trial. CENTRAL EUROPEAN JOURNAL OF SPORT SCIENCES AND MEDICINE 2021. [DOI: 10.18276/cej.2021.3-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Low Stroke Volume Index in Healthy Young Men Is Associated with the Incidence of Acute Mountain Sickness after an Ascent by Airplane: A Case-Control Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6028747. [PMID: 33224980 PMCID: PMC7673943 DOI: 10.1155/2020/6028747] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 10/16/2020] [Accepted: 10/27/2020] [Indexed: 11/17/2022]
Abstract
Background The aims of this study were to explore the characteristics of left ventricular (LV) functional changes in subjects with or without acute mountain sickness (AMS) and their associations with AMS incidence. Methods A total of 589 healthy men were enrolled and took a trip from Chengdu (500 m, above sea level (asl)) to Lhasa (3700 m, asl) by airplane. Basic characteristics, physiological data, and echocardiographic parameters were collected both at Chengdu and Lhasa, respectively. AMS was identified by the Lake Louise Questionnaire Score. Results The oxygen saturation (SpO2), end-systolic volume index, end-diastolic volume index (EDVi), stroke volume index (SVi), E-wave velocity, and E/A ratio were decreased, whereas the heart rate (HR), ejection fraction, cardiac index (CI), and A-wave velocity were increased at the third day after arrival, as evaluated by an oximeter and echocardiography. However, AMS patients showed higher HR and lower EDVi, SVi, CI, E-wave velocity, and E/A ratio than AMS-free subjects. Among them, SVi, which is mainly correlated with the changes of EDVi and altered LV filling pattern, was the most valuable factor associated with AMS incidence following receiver-operator characteristic curves and linear and Poisson regression. Compared with subjects in the highest SVi tertile, subjects in the middle SVi tertile showed higher multivariable Incidence Rate Ratios (IRR) for AMS with higher incidences of mild headache and gastrointestinal symptoms, whereas subjects in the lowest SVi tertile showed even higher multivariable IRR with higher incidences of all the symptoms. Conclusions This relatively large-scale case-control study revealed that the reduction of SVi correlated with the altered LV filling pattern was associated with the incidence and clinical severity of AMS.
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Zhang Z, Qiu M, Du H, Li Q, Yu C, Gan W, Peng H, Xia B, Xiong X, Song X, Yang L, Hu C, Chen J, Yang C, Jiang X. Identification of long noncoding RNAs involved in adaptability to chronic hypoxic by whole transcriptome sequencing. 3 Biotech 2020; 10:269. [PMID: 32523863 DOI: 10.1007/s13205-020-02272-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
Hypoxia affects the physiology of cells and organisms; however, the mechanisms associated with hypoxia adaptation remain unknown in Tibetan chickens. In this study, we aimed to identify long noncoding RNAs (lncRNAs) involved in hypoxia adaptation in Tibetan chickens and Daheng broilers, to provide insights into the mechanisms underlying hypoxia induction. RNA sequencing results revealed that a total of 5504 lncRNAs and 16,779 microRNAs were differentially expressed in four Tibetan chickens and four Daheng broilers; 70 lncRNAs were up-regulated and 113 lncRNAs were down-regulated in the Tibetan chickens compared to the expression levels in the Daheng broilers. The differentially expressed lncRNAs (DElncRNAs) were enriched in the following Gene ontology terms: protein complex localization, small-molecule metabolic process, and RNA splicing. Kyoto Encyclopedia of Genes and Genomes analyses revealed that the DElncRNAs were mainly enriched in pathways that regulate cell junctions and intercellular spaces and oxygen or energy metabolism, mainly involved in hypoxic adaption. Moreover, a predicted ceRNA network with five DElncRNAs interacted with three miRNAs that acted on 42 pathways through 19 target genes. Quantitative real-time polymerase chain reaction was used to verify that the expression levels of ENSGALG00000008047, ENSGALG00000050044, and ENSGALG00000053982 were significantly lower in Tibetan chickens than in the Daheng broilers, consistent with the RNA sequencing results. We obtained lncRNA expression profiles for the heart tissue of Tibetan chickens for the first time and have provided novel data that may aid research on biological adaptation to hypoxic stress.
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Systemic blood pressure at exercise in hypoxia in hypertensive and normotensive patients. J Hypertens 2018; 35:2402-2410. [PMID: 28704259 DOI: 10.1097/hjh.0000000000001479] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The current study aimed to determine whether acute hypoxia exposure in laboratory conditions associated with exercise induces an increase in systemic blood pressure (BP) in normotensive and hypertensive patients, and whether hypertensive patients are more prone to develop severe acute mountain sickness (sAMS). Finally, to determine if BP changes at exercise in acute hypoxia in hypertensive patients are predictive factors for sAMS. METHODS From 2012 to 2015, 852 normotensive and 106 hypertensive patients went through an acute hypoxia exercise test before a sojourn at high altitude. A subgroup of 228 normotensive was selected to match age, sex ratio, body weight and BMI and compared with the hypertensive group. RESULTS In normotensive and hypertensive patients, for a given workload, BP was higher in hypoxia than in normoxia, whereas, for a given heart rate, it was lower in hypoxia than in normoxia. Hypertensive patients treated by beta-blockers showed lower arterial oxygen saturation (vs. other treatments) and blunted cardiac and ventilatory responses to hypoxia at exercise. Based on questionnaires filled out at high altitude, hypertensive patients were not more prone than normotensive patients to develop sAMS. During the laboratory acute hypoxic exercise test, hypertensive patients suffering from sAMS, although taking acetazolamide showed similar BP than hypertensive patients without sAMS and without acetazolamide. DISCUSSION AND CONCLUSION We hypothesize that acute hypoxia with exercise in laboratory conditions induces a peripheral vasodilation that balances vasoconstriction and tachycardia centrally induced through the adrenergic system. Hypertensive and normotensive patients behave similarly during exercise in acute hypoxia. Acute hypoxia does not exacerbate the exercise-induced increase in BP. BP variation, during the acute hypoxia exercise test, is not a useful predictor of intolerance to high altitude. Based on laboratory tests in acute hypoxia, hypertensive patients may not be at higher risk to develop sAMS at high altitude.
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He L, Jiang Y, Su H, Li J, Cheng X. Vascular Endothelial Function Assessed by Postischemic Diastolic Blood Pressure Is Associated with Acclimatization and Acute Mountain Sickness. High Alt Med Biol 2016; 17:11-5. [PMID: 26977539 DOI: 10.1089/ham.2015.0070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study assessed whether the brachial diastolic blood pressure (DBP) decline induced by 5-minute arm ischemia is associated with acclimatization and acute mountain sickness (AMS). METHODS Forty-two age- and body mass index-matched young male residents at sea level (<400 m) or moderate altitude (1000-2000 m above sea level) were enrolled. All subjects had never been to 3200 m before. Brachial BP was measured at a station at 1380 m altitude before and 1, 5, and 10 minutes after right arm ischemia. AMS score was evaluated after 3-day training at a high altitude of 3200 m. RESULTS In moderate altitude versus sea-level residents: (1) systolic BP curves for both arms overlapped well; (2) mean right arm DBP decline post right arm ischemia was larger, while left arm, which was not subjected to ischemia, did not show DBP decline in either group; and (3) AMS scores were significantly lower (3.19 ± 2.16 vs. 5.52 ± 4.58, p = 0.043) in those residing at moderate altitude compared to those from low altitude. There was a low negative correlation between AMS score and right arm area between curves-DBP (r = -0.320, p = 0.039). CONCLUSION Moderate altitude relative to sea-level residents had a larger mean postischemic DBP decline in weak but significant association with lower mean AMS score at 3200 m. These data suggest that differences in vascular endothelial function related to altitude of residence persist during travel to high altitude and might contribute to AMS risk.
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Affiliation(s)
- Lipeng He
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Yu Jiang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Hai Su
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Juxiang Li
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
| | - Xiaoshu Cheng
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University , Nanchang, Jiangxi, China
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Richalet JP, Lhuissier FJ, Larmignat P, Canouï-Poitrine F. Évaluation de la tolérance à l’hypoxie et susceptibilité aux pathologies de haute altitude. Sci Sports 2015. [DOI: 10.1016/j.scispo.2015.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Sightings edited by Erik Swenson and Peter Bärtsch. High Alt Med Biol 2015. [DOI: 10.1089/ham.2015.29000.stg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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