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Titz A, Hoyos R, Ulrich S. Pulmonary vascular diseases at high altitude - is it safe to live in the mountains? Curr Opin Pulm Med 2024; 30:459-463. [PMID: 39036990 PMCID: PMC11343446 DOI: 10.1097/mcp.0000000000001092] [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] [Indexed: 07/23/2024]
Abstract
PURPOSE OF REVIEW This review addresses the concern of the health effects associated with high-altitude living and chronic hypoxia with a focus on pulmonary hypertension. With an increasing global population residing at high altitudes, understanding these effects is crucial for public health interventions and clinical management. RECENT FINDINGS Recent literature on the long-term effects of high-altitude residence and chronic hypoxia is comprehensively summarized. Key themes include the mechanisms of hypoxic pulmonary vasoconstriction, the development of pulmonary hypertension, and challenges in distinguishing altitude-related pulmonary hypertension and classical pulmonary vascular diseases, as found at a low altitude. SUMMARY The findings emphasize the need for research in high-altitude communities to unravel the risks of pulmonary hypertension and pulmonary vascular diseases. Clinically, early and tailored management for symptomatic individuals residing at high altitudes are crucial, as well as access to advanced therapies as proposed by guidelines for pulmonary vascular disease. Moreover, identifying gaps in knowledge underscores the necessity for continued research to improve understanding and clinical outcomes in high-altitude pulmonary vascular diseases.
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Affiliation(s)
| | | | - Silvia Ulrich
- University Hospital of Zurich
- University of Zurich, Zurich, Switzerland
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Hoyos R, Lichtblau M, Cajamarca E, Mayer L, Schwarz EI, Ulrich S. Characteristics and risk profiles of patients with pulmonary arterial or chronic thromboembolic pulmonary hypertension living permanently at >2500 m of high altitude in Ecuador. Pulm Circ 2024; 14:e12404. [PMID: 38974936 PMCID: PMC11224915 DOI: 10.1002/pul2.12404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 05/09/2024] [Accepted: 06/12/2024] [Indexed: 07/09/2024] Open
Abstract
Over 80 Mio people worldwide live >2500 m, including at least as many patients with pulmonary vascular disease (PVD), defined as pulmonary arterial or chronic thromboembolic pulmonary hypertension (PAH/CTEPH), as elsewhere (estimated 0.1‰). Whether PVD patients living at high altitude have altered disease characteristics due to hypobaric hypoxia is unknown. In a cross-sectional study conducted at the Hospital Carlos Andrade Marin in Quito, Ecuador, located at 2840 m, we included 36 outpatients with PAH or CTEPH visiting the clinic from January 2022 to July 2023. We collected data on diagnostic right heart catheterization, treatment, and risk factors, including NYHA functional class (FC), 6-min walk distance (6MWD), and NT-brain natriuretic peptide (BNP) at baseline and at last follow-up. Thirty-six PVD patients (83% women, 32 PAH, 4 CTEPH, mean ± SD age 44 ± 13 years, living altitude 2831 ± 58 m) were included and had the following baseline values: PaO2 8.2 ± 1.6 kPa, PaCO2 3.9 ± 0.5 kPa, SaO2 91 ± 3%, mean pulmonary artery pressure 53 ± 16 mmHg, pulmonary vascular resistance 16 ± 4 WU, 50% FC II, 50% FC III, 6MWD 472 ± 118 m, BNP 490 ± 823 ng/L. Patients were treated for 1628 ± 1186 days with sildenafil (100%), bosentan (33%), calcium channel blockers (33%), diuretics (69%), and oxygen (nocturnal 53%, daytime 11%). Values at last visit were: FC (II 75%, III 25%), 6MWD of 496 ± 108 m, BNP of 576 ± 5774 ng/L. Compared to European PVD registries, ambulatory PVD patients living >2500 m revealed similar blood gases and relatively low and stable risk factor profiles despite severe hemodynamic compromise, suggesting that favorable outcomes are achievable for altitude residents with PVD. Future studies should focus on long-term outcomes in PVD patients dwelling >2500 m.
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Affiliation(s)
| | - Mona Lichtblau
- Department of PulmonologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Laura Mayer
- Department of PulmonologyUniversity Hospital ZurichZurichSwitzerland
| | | | - Silvia Ulrich
- Department of PulmonologyUniversity Hospital ZurichZurichSwitzerland
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Titz A, Schneider S, Mueller J, Mayer L, Lichtblau M, Ulrich S. Symposium review: high altitude travel with pulmonary vascular disease. J Physiol 2024. [PMID: 38780974 DOI: 10.1113/jp284585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 04/26/2024] [Indexed: 05/25/2024] Open
Abstract
Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension are the main precapillary forms of pulmonary hypertension (PH) summarized as pulmonary vascular diseases (PVD). PVDs are characterized by exertional dyspnoea and oxygen desaturation, and reduced quality of life and survival. Medical therapies improve life expectancy and physical performance of PVD patients, of whom many wish to participate in professional work and recreational activities including traveling to high altitude. The exposure to the hypobaric hypoxic environment of mountain regions incurs the risk of high altitude adverse events (AEHA) due to severe hypoxaemia exacerbating symptoms and further increase in pulmonary artery pressure, which may lead to right heart decompensation. Recent prospective and randomized trials show that altitude-induced hypoxaemia, pulmonary haemodynamic changes and impairment of exercise performance in PVD patients are in the range found in healthy people. The vast majority of optimally treated stable PVD patients who do not require long-term oxygen therapy at low altitude can tolerate short-term exposure to moderate altitudes up to 2500 m. PVD patients that reveal persistent severe resting hypoxaemia (S p O 2 ${{S}_{{\mathrm{p}}{{{\mathrm{O}}}_{\mathrm{2}}}}}$ <80% for >30 min) at 2500 m respond well to supplemental oxygen therapy. Although there are no accurate predictors for AEHA, PVD patients with unfavourable risk profiles at low altitude, such as higher WHO functional class, lower exercise capacity with more pronounced exercise-induced desaturation and more severely impaired haemodynamics, are at increased risk of AEHA. Therefore, doctors with experience in PVD and high-altitude medicine should counsel PVD patients before any high-altitude sojourn. This review aims to summarize recent literature and clinical recommendations about PVD patients travelling to high altitude.
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Affiliation(s)
- Anna Titz
- University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | | | | | - Laura Mayer
- University Hospital of Zurich, Zurich, Switzerland
| | | | - Silvia Ulrich
- University Hospital of Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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Aguirre-Franco C, Torres-Duque CA, Salazar G, Casas A, Jaramillo C, Gonzalez-Garcia M. Prevalence of pulmonary hypertension in COPD patients living at high altitude. Pulmonology 2024; 30:247-253. [PMID: 35151623 DOI: 10.1016/j.pulmoe.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is associated with poor prognosis for patients with chronic obstructive pulmonary disease (COPD). Most of the knowledge about PH in COPD has been generated at sea level, with limited information associated with high altitude (HA). OBJECTIVES To assess the prevalence and severity of PH in COPD patients living in a HA city (2,640 m). METHODS Cross-sectional study in COPD patients with forced expiratory volume in the first second / forced vital capacity ratio (FEV1/FVC) post-bronchodilator <0,7. Transthoracic echocardiography (TTE), spirometry, carbon monoxide diffusing capacity, and arterial blood gasses tests were performed. Patients were classified according to the severity of airflow limitation. PH was defined by TTE as an estimated systolic pulmonary artery pressure (sPAP) > 36 mmHg or indirect PH signs; severe PH as sPAP > 60 mmHg; and disproportionate PH as an sPAP > 60 mmHg with non-severe airflow limitation (FEV1 > 50% predicted). RESULTS We included 176 COPD patients. The overall estimated prevalence of PH was 56.3% and the likelihood of having PH increased according to airflow-limitation severity: mild (31.6%), moderate (54.9%), severe (59.6%) and very severe (77.8%) (p = 0.038). The PH was severe in 7.3% and disproportionate in 3.4% of patients. CONCLUSIONS The estimated prevalence of PH in patients with COPD at HA is high, particularly in patients with mild to moderate airflow limitation, and greater than that described for COPD patients at low altitude. These results suggest a higher risk of developing PH for COPD patients living at HA compared to COPD patients with similar airflow limitation living at low altitude.
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Affiliation(s)
- C Aguirre-Franco
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia.
| | - C A Torres-Duque
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
| | - G Salazar
- Fundación Cardioinfantil - Instituto de Cardiología. Bogotá, Colombia
| | - A Casas
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
| | - C Jaramillo
- Universidad de La Sabana. Chía, Colombia; Fundación Clínica Shaio. Bogotá, Colombia
| | - M Gonzalez-Garcia
- Fundación Neumológica Colombiana. Bogotá, Colombia; Universidad de La Sabana. Chía, Colombia
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Zhao ML, Lu ZJ, Yang L, Ding S, Gao F, Liu YZ, Yang XL, Li X, He SY. The cardiovascular system at high altitude: A bibliometric and visualization analysis. World J Cardiol 2024; 16:199-214. [PMID: 38690218 PMCID: PMC11056872 DOI: 10.4330/wjc.v16.i4.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND When exposed to high-altitude environments, the cardiovascular system undergoes various changes, the performance and mechanisms of which remain controversial. AIM To summarize the latest research advancements and hot research points in the cardiovascular system at high altitude by conducting a bibliometric and visualization analysis. METHODS The literature was systematically retrieved and filtered using the Web of Science Core Collection of Science Citation Index Expanded. A visualization analysis of the identified publications was conducted employing CiteSpace and VOSviewer. RESULTS A total of 1674 publications were included in the study, with an observed annual increase in the number of publications spanning from 1990 to 2022. The United States of America emerged as the predominant contributor, while Universidad Peruana Cayetano Heredia stood out as the institution with the highest publication output. Notably, Jean-Paul Richalet demonstrated the highest productivity among researchers focusing on the cardiovascular system at high altitude. Furthermore, Peter Bärtsch emerged as the author with the highest number of cited articles. Keyword analysis identified hypoxia, exercise, acclimatization, acute and chronic mountain sickness, pulmonary hypertension, metabolism, and echocardiography as the primary research hot research points and emerging directions in the study of the cardiovascular system at high altitude. CONCLUSION Over the past 32 years, research on the cardiovascular system in high-altitude regions has been steadily increasing. Future research in this field may focus on areas such as hypoxia adaptation, metabolism, and cardiopulmonary exercise. Strengthening interdisciplinary and multi-team collaborations will facilitate further exploration of the pathophysiological mechanisms underlying cardiovascular changes in high-altitude environments and provide a theoretical basis for standardized disease diagnosis and treatment.
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Affiliation(s)
- Mao-Lin Zhao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Zhong-Jie Lu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Li Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Feng Gao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Yuan-Zhang Liu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xue-Lin Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xia Li
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Si-Yi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China.
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Zeng Y, Zhakeer G, Li B, Yu Q, Niu M, Maimaitiaili N, Mi M, Deji Z, Zhuang J, Peng W. A novel clinical prediction scoring system of high-altitude pulmonary hypertension. Front Cardiovasc Med 2024; 10:1290895. [PMID: 38259305 PMCID: PMC10801263 DOI: 10.3389/fcvm.2023.1290895] [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: 10/23/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background High-altitude pulmonary hypertension (HAPH) is a common disease in regions of high altitude where performing right heart catheterization (RHC) is challenging. The development of a diagnostic scoring system is crucial for effective disease screening. Methods A total of 148 individuals were included in a retrospective analysis, and an additional 42 residents were prospectively enrolled. We conducted a multivariable analysis to identify independent predictors of HAPH. Subsequently, we devised a prediction score based on the retrospective training set to anticipate the occurrence and severity of HAPH. This scoring system was further subjected to validation in the prospective cohort, in which all participants underwent RHC. Results This scoring system, referred to as the GENTH score model (Glycated hemoglobin [OR = 4.5], Echocardiography sign [OR = 9.1], New York Heart Association-functional class [OR = 12.5], Total bilirubin [OR = 3.3], and Hematocrit [OR = 3.6]), incorporated five independent risk factors and demonstrated strong predictive accuracy. In the training set, the area under the curve (AUC) values for predicting the occurrence and severity of HAPH were 0.851 and 0.832, respectively, while in the validation set, they were 0.841 and 0.893. In the validation set, GENTH score model cutoff values of ≤18 or >18 points were established for excluding or confirming HAPH, and a threshold of >30 points indicated severe HAPH. Conclusions The GENTH score model, combining laboratory and echocardiography indicators, represents an effective tool for distinguishing potential HAPH patients and identifying those with severe HAPH. This scoring system improves the clinical screening of HAPH diseases and offers valuable insights into disease diagnosis and management.
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Affiliation(s)
- Yanxi Zeng
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Gulinigeer Zhakeer
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bingyu Li
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qing Yu
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Mingyuan Niu
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Nuerbiyemu Maimaitiaili
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ma Mi
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Zhuoga Deji
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
| | - Jianhui Zhuang
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wenhui Peng
- Department of Cardiology, Shigatse People’s Hospital, Tibet, China
- Department of Cardiology, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
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Halank M, Zeder KE, Sommer N, Ulrich S, Held M, Köhler T, Foris V, Heberling M, Neurohr C, Ronczka J, Holt S, Skowasch D, Kneidinger N, Behr J. [Pulmonary hypertension associated with lung disease]. Pneumologie 2023; 77:916-925. [PMID: 37963481 DOI: 10.1055/a-2145-4756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Lung diseases and hypoventilation syndromes are often associated with pulmonary hypertension (PH). In most cases, PH is not severe. This is defined hemodynamically by a mean pulmonary arterial pressure (PAPm) > 20 mmHg, a pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg and a pulmonary vascular resistance of ≤ 5 Wood units (WU). Both the non-severe (PVR ≤ 5 WU) and much more the severe PH (PVR > 5 WU) have an unfavorable prognosis.If PH is suspected, it is recommended to primarily check whether risk factors for pulmonary arterial hypertension (PAH, group 1 PH) or chronic thromboembolic pulmonary hypertension (CTEPH, group 4 PH) are present. If risk factors are present or there is a suspicion of severe PH in lung patients, it is recommended that the patient should be presented to a PH outpatient clinic promptly.For patients with severe PH associated with lung diseases, personalized, individual therapy is recommended - if possible within the framework of therapy studies. Currently, a therapy attempt with PH specific drugs should only be considered in COPD patients if the associated PH is severe and a "pulmonary vascular" phenotype (severe precapillary PH, but typically only mild to moderate airway obstruction, no or mild hypercapnia and DLCO < 45 % of predicted value) is present. In patients with severe PH associated with interstitial lung disease phosphodiesterase-5-inhibitors may be considered in individual cases. Inhaled treprostinil may be considered also in non-severe PH in this patient population.
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Affiliation(s)
- Michael Halank
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Med. Klinik I, Bereich Pneumologie, Dresden, Deutschland
| | - Katarina E Zeder
- Klinische Abteilung für Pulmonologie, Med. Universität Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung, Graz, Österreich
| | - Natascha Sommer
- Justus-Liebig-Universitätsklinikum Gießen, Medizinische Klinik II, Pneumologie
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Universities of Giessen and Marburg Lung Center (UGMLC)
| | | | - Matthias Held
- Klinikum Würzburg Mitte, Medizinische Klinik Schwerpunkt Pneumologie & Beatmungsmedizin
| | - Thomas Köhler
- Universitätsklinikum Freiburg, Department Innere Medizin, Klinik für Pneumologie, Freiburg, Deutschland
| | - Vasile Foris
- Klinische Abteilung für Pulmonologie, Med. Universität Graz, Österreich
- Ludwig Boltzmann Institut für Lungengefäßforschung, Graz, Österreich
| | - Melanie Heberling
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Med. Klinik I, Bereich Pneumologie, Dresden, Deutschland
| | - Claus Neurohr
- RBK Lungenzentrum Stuttgart am Robert-Bosch-Krankenhaus, Abteilung Pneumologie und Beatmungsmedizin, Stuttgart, Deutschland
| | - Julia Ronczka
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Med. Klinik I, Bereich Pneumologie, Dresden, Deutschland
| | | | - Dirk Skowasch
- Universitätsklinikum Bonn, Med. Klinik und Poliklinik II, Sektion Pneumologie, Bonn, Deutschland
| | - Nikolaus Kneidinger
- Medizinische Klinik und Poliklinik V, LMU Klinikum, LMU München, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München, Deutschland
| | - Jürgen Behr
- Medizinische Klinik und Poliklinik V, LMU Klinikum, LMU München, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München, Deutschland
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Peng W, Li H, Xia C, Guo Y, Xu X, Zeng W, Liu K, Che Q, Jiang Y, Xiang K, Zhou X, Li G, Li Z. Cardiovascular indicators associated with ventricular remodeling in chronic high-altitude disease: a cardiovascular MRI study. Eur Radiol 2023; 33:6267-6277. [PMID: 37036481 DOI: 10.1007/s00330-023-09574-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVE This study aimed to assess biventricular function and mechanics in patients with the chronic high-altitude disease (CHAD) using cardiovascular MRI and explore the possible risk factors associated with ventricular remodeling. METHODS In this prospective study, consecutive CHAD patients and healthy controls at high-altitude (HA) and at sea level (SL) underwent cardiovascular MRI. Right ventricular (RV) and left ventricular (LV) function and global strain parameters were compared. To identify risk factors associated with ventricular remodeling, multiple linear regression analyses were used. RESULTS A total of 33 patients with CHAD (42.97 years ± 11.80; 23 men), 33 HA (41.18 years ± 8.58; 21 men), and 33 SL healthy controls (43.48 years ± 13.40; 21 men) were included. A Significantly decreased biventricular ejection fraction was observed in patients (all p < 0.05). Additionally, the HA group displayed lower magnitudes of biventricular longitudinal peak strain (PS) (RV, - 13.67% ± 4.05 vs. - 16.22% ± 3.03; LV, - 14.68% ± 2.20 vs. - 16.19% ± 2.51; both p < 0.05), but a higher LV circumferential PS (- 20.74% ± 2.02 vs. - 19.17% ± 2.34, p < 0.05) than the SL group. Moreover, multiple linear regression analyses revealed that HGB (β = 0.548) was related to the LV remodeling index, whereas BUN (β = 0.570) was associated with the RV remodeling index. CONCLUSIONS With the deterioration of RV function in patients with CHAD, LV function was also impaired concomitantly. Hypoxia-induced erythrocytosis may contribute to LV impairment, while BUN was considered an independent risk factor for RV remodeling. KEY POINTS • A significantly lower biventricular ejection fraction was observed in patients, with a decreased magnitude of left ventricular (LV) peak systolic strain rate (radial and circumferential) and peak diastolic strain rate (all p < 0.05). • High-altitude healthy natives showed a lower biventricular longitudinal peak strain (all p < 0.05). • Hemoglobin was related to LV remodeling (β = 0.548), while BUN (β = 0.570) was independently associated with RV remodeling in CHAD patients.
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Affiliation(s)
- Wanlin Peng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Hongwei Li
- Department of Cardiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, 20# Ximianqiao Street, Chengdu, 610041, Sichuan, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Yingkun Guo
- Department of Radiology, West China Second University Hospital, Sichuan University, 20# South ren Min Road, Chengdu, 610041, Sichuan, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Ren Min Road, Chengdu, 610041, Sichuan, China
| | - Xu Xu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Wen Zeng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Keling Liu
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Qianqiu Che
- Department of Cardiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, 20# Ximianqiao Street, Chengdu, 610041, Sichuan, China
| | - Yuexin Jiang
- Department of Radiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, 20# Ximianqiao Street, Chengdu, 610041, Sichuan, China
| | - Kejin Xiang
- Department of Radiology, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, 20# Ximianqiao Street, Chengdu, 610041, Sichuan, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, 200126, China
| | - Gang Li
- Department of Radiology, The People's Hospital of Ningnan County Sichuan Province, Ningnan, 615400, Sichuan, China
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Li L, Lin L, Wen B, Zhao PC, Liu DS, Pang GM, Wang ZR, Tan Y, Lu C. Promising Natural Medicines for the Treatment of High-Altitude Illness. High Alt Med Biol 2023; 24:175-185. [PMID: 37504973 PMCID: PMC10516238 DOI: 10.1089/ham.2022.0139] [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: 12/08/2022] [Accepted: 06/27/2023] [Indexed: 07/29/2023] Open
Abstract
Li Li, Lin Lin, Bo Wen, Peng-cheng Zhao, Da-sheng Liu, Guo-ming Pang, Zi-rong Wang, Yong Tan, and Cheng Lu. Promising natural medicines for the treatment of high-altitude illness. High Alt Med Biol. 24:175-185, 2023.-High-altitude illness (HAI) is a dangerous disease characterized by oxidative stress, inflammatory damage and hemodynamic changes in the body that can lead to severe damage to the lungs, heart, and brain. Natural medicines are widely known for their multiple active ingredients and pharmacological effects, which may be important in the treatment of HAI. In this review, we outline the specific types of HAI and the underlying pathological mechanisms and summarize the currently documented natural medicines applied in the treatment of acute mountain sickness and high-altitude cerebral edema, high-altitude pulmonary edema, chronic mountain sickness, and high-altitude pulmonary hypertension. Their sources, types, and medicinal sites are summarized, and their active ingredients, pharmacological effects, related mechanisms, and potential toxicity are discussed. In conclusion, natural medicines, as an acceptable complementary and alternative strategy with fewer side effects and more long-term application, can provide a reference for developing more natural antialtitude sickness medicines in the future and have good application prospects in HAI treatment.
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Affiliation(s)
- Li Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lin Lin
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Bo Wen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Peng-cheng Zhao
- School of Life Science, Northwestern Polytechnical University, Xi'an, China
| | - Da-sheng Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guo-ming Pang
- Kaifeng Traditional Chinese Medicine Hospital, Kaifeng, China
| | - Zi-rong Wang
- Logistics Support Division, National Immigration Administration, Beijing, China
| | - Yong Tan
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Cheng Lu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Ye X, Sun M, Yu S, Yang J, Liu Z, Lv H, Wu B, He J, Wang X, Huang L. Smartwatch-Based Maximum Oxygen Consumption Measurement for Predicting Acute Mountain Sickness: Diagnostic Accuracy Evaluation Study. JMIR Mhealth Uhealth 2023; 11:e43340. [PMID: 37410528 PMCID: PMC10360014 DOI: 10.2196/43340] [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: 10/09/2022] [Revised: 12/11/2022] [Accepted: 06/09/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Cardiorespiratory fitness plays an important role in coping with hypoxic stress at high altitudes. However, the association of cardiorespiratory fitness with the development of acute mountain sickness (AMS) has not yet been evaluated. Wearable technology devices provide a feasible assessment of cardiorespiratory fitness, which is quantifiable as maximum oxygen consumption (VO2max) and may contribute to AMS prediction. OBJECTIVE We aimed to determine the validity of VO2max estimated by the smartwatch test (SWT), which can be self-administered, in order to overcome the limitations of clinical VO2max measurements. We also aimed to evaluate the performance of a VO2max-SWT-based model in predicting susceptibility to AMS. METHODS Both SWT and cardiopulmonary exercise test (CPET) were performed for VO2max measurements in 46 healthy participants at low altitude (300 m) and in 41 of them at high altitude (3900 m). The characteristics of the red blood cells and hemoglobin levels in all the participants were analyzed by routine blood examination before the exercise tests. The Bland-Altman method was used for bias and precision assessment. Multivariate logistic regression was performed to analyze the correlation between AMS and the candidate variables. A receiver operating characteristic curve was used to evaluate the efficacy of VO2max in predicting AMS. RESULTS VO2max decreased after acute high altitude exposure, as measured by CPET (25.20 [SD 6.46] vs 30.17 [SD 5.01] at low altitude; P<.001) and SWT (26.17 [SD 6.71] vs 31.28 [SD 5.17] at low altitude; P<.001). Both at low and high altitudes, VO2max was slightly overestimated by SWT but had considerable accuracy as the mean absolute percentage error (<7%) and mean absolute error (<2 mL·kg-1·min-1), with a relatively small bias compared with VO2max-CPET. Twenty of the 46 participants developed AMS at 3900 m, and their VO2max was significantly lower than that of those without AMS (CPET: 27.80 [SD 4.55] vs 32.00 [SD 4.64], respectively; P=.004; SWT: 28.00 [IQR 25.25-32.00] vs 32.00 [IQR 30.00-37.00], respectively; P=.001). VO2max-CPET, VO2max-SWT, and red blood cell distribution width-coefficient of variation (RDW-CV) were found to be independent predictors of AMS. To increase the prediction accuracy, we used combination models. The combination of VO2max-SWT and RDW-CV showed the largest area under the curve for all parameters and models, which increased the area under the curve from 0.785 for VO2max-SWT alone to 0.839. CONCLUSIONS Our study demonstrates that the smartwatch device can be a feasible approach for estimating VO2max. In both low and high altitudes, VO2max-SWT showed a systematic bias toward a calibration point, slightly overestimating the proper VO2max when investigated in healthy participants. The SWT-based VO2max at low altitude is an effective indicator of AMS and helps to better identify susceptible individuals following acute high-altitude exposure, particularly by combining the RDW-CV at low altitude. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2200059900; https://www.chictr.org.cn/showproj.html?proj=170253.
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Affiliation(s)
- Xiaowei Ye
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Mengjia Sun
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shiyong Yu
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Yang
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zhen Liu
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hailin Lv
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Boji Wu
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jingyu He
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xuhong Wang
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lan Huang
- Institute of Cardiovascular Diseases of People's Liberation Army, The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China
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Zhu P, Zhu J, Tong S, She X, Qi Z, Xu Q, Shi Z, Si L, Hou M, Gan G, Pan C. Clinical characteristics of patients with a risk of pulmonary artery hypertension secondary to ARDS in a high-altitude area. BMJ Open Respir Res 2023; 10:e001475. [PMID: 37524522 PMCID: PMC10391833 DOI: 10.1136/bmjresp-2022-001475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Hypoxaemia plays an important role in the development of pulmonary artery hypertension (PAH). Patients with acute respiratory distress syndrome (ARDS) in a high-altitude area have different pathophysiological characteristics from those patients in the plains. The goal of our study was to explore the clinical characteristics of PAH secondary to ARDS in a high-altitude area. METHODS This was a prospective study conducted in the affiliated Hospital of Qinghai University. Two investigators independently assessed pulmonary artery pressure (PAP) and right ventricular function by transthoracic echocardiography. Basic information and clinical data of the patients who were enrolled were collected. A multivariable logistic regression model was used to evaluate the risk factors for PAH secondary to ARDS in the high-altitude area. RESULTS The incidence of PAH secondary to ARDS within 48 hours in the high-altitude area was 44.19%. Partial pressure of oxygen/fraction of inspired oxygen <165.13 mm Hg was an independent risk factor for PAH secondary to ARDS in the high-altitude area. Compared with the normal PAP group, the right ventricular basal dimensions were significantly larger and the right ventricular tricuspid annular plane systolic excursion was lower in the PAH group (right ventricular basal dimensions: 45.47±2.60 vs 40.67±6.12 mm, p=0.019; tricuspid annular plane systolic excursion (TAPSE): 1.82±0.40 vs 2.09±0.32 cm, p=0.021). The ratio of TAPSE to systolic PAP was lower in the PAH group (0.03±0.01 vs 0.08±0.03 cm/mm Hg, p<0.001). CONCLUSIONS The incidence of PAH in patients with ARDS in our study is high. PAH secondary to ARDS in a high-altitude area could cause right ventricular dysfunction. TRIAL REGISTRATION NUMBER NCT05166759.
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Affiliation(s)
- Peng Zhu
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Jing Zhu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Shijun Tong
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Xiaobin She
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Zhenyuan Qi
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Qianjin Xu
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Zhongshan Shi
- Department of Critical Care Medicine, People's Hospital of Golmud City, Golmud, Qinghai, China
| | - Lining Si
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Ming Hou
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Guifen Gan
- Department of Critical Care Medicine, Qinghai University Affiliated Hospital, Xining, Qinghai, China
| | - Chun Pan
- Department of Critical Care Medicine, Health Management Center, University of Electronic Science and Technology of China Sichuan Provincial People's Hospital, Chengdu, Sichuan, China
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Wang L, Wang F, Tuo Y, Wan H, Luo F. Clinical characteristics and predictors of pulmonary hypertension in chronic obstructive pulmonary disease at different altitudes. BMC Pulm Med 2023; 23:127. [PMID: 37072815 PMCID: PMC10111800 DOI: 10.1186/s12890-023-02405-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a common complication in patients with chronic obstructive pulmonary disease (COPD) and is closely associated with poor prognosis. However, studies on the predictors of PH in COPD patients are limited, especially in populations living at high altitude (HA). OBJECTIVES To investigate the differences in the clinical characteristics and predictors of patients with COPD/COPD and PH (COPD-PH) from low altitude (LA, 600 m) and HA (2200 m). METHODS We performed a cross-sectional survey of 228 COPD patients of Han nationality admitted to the respiratory department of Qinghai People's Hospital (N = 113) and West China Hospital of Sichuan University (N = 115) between March 2019 and June 2021. PH was defined as a pulmonary arterial systolic pressure (PASP) > 36 mmHg measured using transthoracic echocardiography (TTE). RESULTS The proportion of PH in COPD patients living at HA was higher than that in patients living at LA (60.2% vs. 31.3%). COPD-PH patients from HA showed significantly different in baseline characteristics, laboratory tests and pulmonary function test. Multivariate logistic regression analysis indicated that the predictors of PH in COPD patients were different between the HA and LA groups. CONCLUSIONS The COPD patients living at HA had a higher proportion of PH than those living at LA. At LA, increased B-type natriuretic peptide (BNP) and direct bilirubin (DB) were predictors for PH in COPD patients. However, at HA, increased DB was a predictor of PH in COPD patients.
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Affiliation(s)
- Lixia Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Faping Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yajun Tuo
- Department of Respiratory and Critical Care Medicine, Qinghai Provincial People's Hospital, Xining, China
| | - Huajing Wan
- Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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13
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Gu S, Goel K, Forbes LM, Kheyfets VO, Yu YRA, Tuder RM, Stenmark KR. Tensions in Taxonomies: Current Understanding and Future Directions in the Pathobiologic Basis and Treatment of Group 1 and Group 3 Pulmonary Hypertension. Compr Physiol 2023; 13:4295-4319. [PMID: 36715285 PMCID: PMC10392122 DOI: 10.1002/cphy.c220010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In the over 100 years since the recognition of pulmonary hypertension (PH), immense progress and significant achievements have been made with regard to understanding the pathophysiology of the disease and its treatment. These advances have been mostly in idiopathic pulmonary arterial hypertension (IPAH), which was classified as Group 1 Pulmonary Hypertension (PH) at the Second World Symposia on PH in 1998. However, the pathobiology of PH due to chronic lung disease, classified as Group 3 PH, remains poorly understood and its treatments thus remain limited. We review the history of the classification of the five groups of PH and aim to provide a state-of-the-art review of the understanding of the pathogenesis of Group 1 PH and Group 3 PH including insights gained from novel high-throughput omics technologies that have revealed heterogeneities within these categories as well as similarities between them. Leveraging the substantial gains made in understanding the genomics, epigenomics, proteomics, and metabolomics of PAH to understand the full spectrum of the complex, heterogeneous disease of PH is needed. Multimodal omics data as well as supervised and unbiased machine learning approaches after careful consideration of the powerful advantages as well as of the limitations and pitfalls of these technologies could lead to earlier diagnosis, more precise risk stratification, better predictions of disease response, new sub-phenotype groupings within types of PH, and identification of shared pathways between PAH and other types of PH that could lead to new treatment targets. © 2023 American Physiological Society. Compr Physiol 13:4295-4319, 2023.
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Affiliation(s)
- Sue Gu
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
- Cardiovascular Pulmonary Research Lab, University of Colorado School of Medicine, Colorado, USA
- National Jewish Health, Denver, Colorodo, USA
| | - Khushboo Goel
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
- National Jewish Health, Denver, Colorodo, USA
| | - Lindsay M. Forbes
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Vitaly O. Kheyfets
- Cardiovascular Pulmonary Research Lab, University of Colorado School of Medicine, Colorado, USA
| | - Yen-rei A. Yu
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
- Cardiovascular Pulmonary Research Lab, University of Colorado School of Medicine, Colorado, USA
| | - Rubin M. Tuder
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
- Program in Translational Lung Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
| | - Kurt R. Stenmark
- Cardiovascular Pulmonary Research Lab, University of Colorado School of Medicine, Colorado, USA
- Department of Pediatrics Section of Critical Care Medicine, University of Colorado Anschutz Medical Campus, Colorado, USA
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14
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Ulrich S, Lichtblau M, Schneider SR, Saxer S, Bloch KE. Clinician's Corner: Counseling Patients with Pulmonary Vascular Disease Traveling to High Altitude. High Alt Med Biol 2022; 23:201-208. [PMID: 35852848 DOI: 10.1089/ham.2022.0051] [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] [Indexed: 11/12/2022] Open
Abstract
Ulrich, Silvia, Mona Lichtblau, Simon R. Schneider, Stéphanie Saxer, and Konrad E. Bloch, Clinician's corner: counseling patients with pulmonary vascular disease traveling to high altitude. High Alt Med Biol. 23:201-208, 2022.-Pulmonary vascular diseases (PVDs) with precapillary pulmonary hypertension (PH), such as pulmonary arterial or chronic thromboembolic PH, impair exercise performance and survival in patients. Vasodilators and other treatments improve quality of life and prognosis to an extent in patients who have PVDs as chronic disorders. Obviously, patients with PVD wish to participate in usual daily activities, including travel to popular settlements and mountainous regions located at high altitude. However, the pulmonary hemodynamic impairment due to PVD leads to blood and tissue hypoxia, particularly during exercise and sleep. It is thus of concern that alveolar hypoxia at higher altitude may exacerbate patients' symptoms and lead to decompensation. Current PH guidelines discourage high-altitude exposure for fear of altitude-related adverse health effects. However, several recent well-designed prospective and randomized trials show that despite altitude-induced hypoxemia, pulmonary hemodynamic changes and impairment of exercise performance in patients with PVD are similar to the responses in healthy people or in patients with mild chronic obstructive pulmonary disease. The vast majority of patients with PVD can tolerate short-term exposure to moderate altitudes up to 2,500 m. For the roughly 10% of patients with stable disease who develop severe hypoxemia when ascending to 2,500 m, they respond well to low-level supplemental oxygen support. The best low-altitude predictors for adverse health effects at high altitude are the known clinical risk factors for PVD such as symptoms, functional class, exercise capacity, and exertional oxygen desaturation, whereas hypoxia altitude simulation testing is of little additive value. In any case, patients should be instructed that altitude-related adverse health effects may be difficult to predict and that in case of worsening symptoms, immediate accompanied descent to lower altitude and oxygen therapy are required. Patients with severe hypoxemia near sea level may safely visit high-altitude regions up to 1,500-2,000 m while continuing oxygen therapy and avoiding strenuous exercise. All PH patients should be counseled before any high-altitude sojourn by doctors with experience in PVD and high-altitude medicine and have an action plan for the occurrence of severe hypoxemia and other altitude-related conditions such as acute mountain sickness.
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Affiliation(s)
- Silvia Ulrich
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Simon R Schneider
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
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15
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Wei Y, Giunta S, Xia S. Hypoxia in Aging and Aging-Related Diseases: Mechanism and Therapeutic Strategies. Int J Mol Sci 2022; 23:8165. [PMID: 35897741 PMCID: PMC9330578 DOI: 10.3390/ijms23158165] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
As the global aging process continues to lengthen, aging-related diseases (e.g., chronic obstructive pulmonary disease (COPD), heart failure) continue to plague the elderly population. Aging is a complex biological process involving multiple tissues and organs and is involved in the development and progression of multiple aging-related diseases. At the same time, some of these aging-related diseases are often accompanied by hypoxia, chronic inflammation, oxidative stress, and the increased secretion of the senescence-associated secretory phenotype (SASP). Hypoxia seems to play an important role in the process of inflammation and aging, but is often neglected in advanced clinical research studies. Therefore, we have attempted to elucidate the role played by different degrees and types of hypoxia in aging and aging-related diseases and their possible pathways, and propose rational treatment options based on such mechanisms for reference.
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Affiliation(s)
- Yaqin Wei
- Department of Geriatrics, Shanghai Institute of Geriatrics, Huadong Hospital, Fudan University, Shanghai 200000, China;
| | - Sergio Giunta
- Casa di Cura Prof. Nobili–GHC Garofalo Health Care, 40035 Bologna, Italy;
| | - Shijin Xia
- Department of Geriatrics, Shanghai Institute of Geriatrics, Huadong Hospital, Fudan University, Shanghai 200000, China;
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Chen X, Liu B, Deng Y, Yang F, Wang W, Lin X, Yu L, Pu H, Zhang P, Li Z, Zhong Q, Jia Q, Li Y, Wang X, Chen W, Burkhoff D, He K. Cardiac Adaptation to Prolonged High Altitude Migration Assessed by Speckle Tracking Echocardiography. Front Cardiovasc Med 2022; 9:856749. [PMID: 35677688 PMCID: PMC9167963 DOI: 10.3389/fcvm.2022.856749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Exposure to high altitudes represents physiological stress that leads to significant changes in cardiovascular properties. However, long-term cardiovascular adaptions to high altitude migration of lowlanders have not been described. Accordingly, we measured changes in cardiovascular properties following prolonged hypoxic exposure in acclimatized Han migrants and Tibetans. Methods Echocardiographic features of recently adapted Han migrant (3–12 months, n = 64) and highly adapted Han migrant (5–10 years, n = 71) residence in Tibet (4,300 m) using speckle tracking echocardiography were compared to those of age-matched native Tibetans (n = 75) and Han lowlanders living at 1,400 m (n = 60). Results Short-term acclimatized migrants showed increased estimated pulmonary artery systolic pressure (PASP) (32.6 ± 5.1 mmHg vs. 21.1 ± 4.2 mmHg, p < 0.05), enlarged right ventricles (RVs), and decreased fractional area change (FAC) with decreased RV longitudinal strain (−20 ± 2.8% vs. −25.5 ± 3.9%, p < 0.05). While left ventricular ejection fraction (LVEF) was preserved, LV diameter (41.7 ± 3.1 mm vs. 49.7 ± 4.8 mm, p < 0.05) and LV longitudinal strain (−18.8 ± 3.2% vs. −22.9 ± 3.3%, p < 0.05) decreased. Compared with recent migrants, longer-term migrants had recovered RV structure and functions with slightly improved RV and LV longitudinal strain, though still lower than lowlander controls; LV size remained small with increased mass index (68.3 ± 12.7 vs. 59.3 ± 9.6, p < 0.05). In contrast, native Tibetans had slightly increased PASP (26.1 ± 3.4 mmHg vs. 21.1 ± 4.2 mmHg, p < 0.05) with minimally altered cardiac deformation compared to lowlanders. Conclusion Right ventricular systolic function is impaired in recent (<1 year) migrants to high altitudes but improved during the long-term dwelling. LV remodeling persists in long-term migrants (>5 years) but without impairment of LV systolic or diastolic function. In contrast, cardiac size, structure, and function of native Tibetans are more similar to those of lowland dwelling Hans.
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Affiliation(s)
- Xu Chen
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Bohan Liu
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yujiao Deng
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Feifei Yang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Wenjun Wang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Xixiang Lin
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Liheng Yu
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Haitao Pu
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Peifang Zhang
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Zongren Li
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Qin Zhong
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Jia
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yao Li
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Xiao Wang
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
| | - Wei Chen
- Department of Ultrasound Diagnosis, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, United States
| | - Kunlun He
- Beijing Key Laboratory for Precision Medicine of Chronic Heart Failure, Key Laboratory of Ministry of Industry and Information Technology of Biomedical Engineering and Translational Medicine, Translational Medicine Research Center, Medical Artificial Intelligence Research Center, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Kunlun He
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17
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Schneider SR, Lichtblau M, Furian M, Mayer LC, Berlier C, Müller J, Saxer S, Schwarz EI, Bloch KE, Ulrich S. Cardiorespiratory Adaptation to Short-Term Exposure to Altitude vs. Normobaric Hypoxia in Patients with Pulmonary Hypertension. J Clin Med 2022; 11:jcm11102769. [PMID: 35628896 PMCID: PMC9147287 DOI: 10.3390/jcm11102769] [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: 04/04/2022] [Revised: 05/05/2022] [Accepted: 05/12/2022] [Indexed: 02/01/2023] Open
Abstract
Prediction of adverse health effects at altitude or during air travel is relevant, particularly in pre-existing cardiopulmonary disease such as pulmonary arterial or chronic thromboembolic pulmonary hypertension (PAH/CTEPH, PH). A total of 21 stable PH-patients (64 ± 15 y, 10 female, 12/9 PAH/CTEPH) were examined by pulse oximetry, arterial blood gas analysis and echocardiography during exposure to normobaric hypoxia (NH) (FiO2 15% ≈ 2500 m simulated altitude, data partly published) at low altitude and, on a separate day, at hypobaric hypoxia (HH, 2500 m) within 20−30 min after arrival. We compared changes in blood oxygenation and estimated pulmonary artery pressure in lowlanders with PH during high altitude simulation testing (HAST, NH) with changes in response to HH. During NH, 4/21 desaturated to SpO2 < 85% corresponding to a positive HAST according to BTS-recommendations and 12 qualified for oxygen at altitude according to low SpO2 < 92% at baseline. At HH, 3/21 received oxygen due to safety criteria (SpO2 < 80% for >30 min), of which two were HAST-negative. During HH vs. NH, patients had a (mean ± SE) significantly lower PaCO2 4.4 ± 0.1 vs. 4.9 ± 0.1 kPa, mean difference (95% CI) −0.5 kPa (−0.7 to −0.3), PaO2 6.7 ± 0.2 vs. 8.1 ± 0.2 kPa, −1.3 kPa (−1.9 to −0.8) and higher tricuspid regurgitation pressure gradient 55 ± 4 vs. 45 ± 4 mmHg, 10 mmHg (3 to 17), all p < 0.05. No serious adverse events occurred. In patients with PH, short-term exposure to altitude of 2500 m induced more pronounced hypoxemia, hypocapnia and pulmonary hemodynamic changes compared to NH during HAST despite similar exposure times and PiO2. Therefore, the use of HAST to predict physiological changes at altitude remains questionable. (ClinicalTrials.gov: NCT03592927 and NCT03637153).
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Affiliation(s)
- Simon R. Schneider
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
- Department of Health Sciences and Medicine, University of Lucerne, Frohburgstrasse 3, 6005 Lucerne, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Michael Furian
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Laura C. Mayer
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Charlotte Berlier
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Julian Müller
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Stéphanie Saxer
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Esther I. Schwarz
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Konrad E. Bloch
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland; (S.R.S.); (M.L.); (M.F.); (L.C.M.); (C.B.); (J.M.); (S.S.); (E.I.S.); (K.E.B.)
- Correspondence:
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18
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Parodi JB, Ramchandani R, Zhou Z, Chango DX, Acunzo R, Liblik K, Farina JM, Zaidel EJ, Ruiz-Mori E, Carreón JMA, Liprandi AS, Baranchuk A. A systematic review of electrocardiographic changes in healthy high-altitude populations. Trends Cardiovasc Med 2022:S1050-1738(22)00015-9. [PMID: 35121084 DOI: 10.1016/j.tcm.2022.01.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/17/2022] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
High-altitude environments are characterized by decreased atmospheric pressures at which individuals exhibit a reduced volume of maximal oxygen uptake and arterial partial pressure of oxygen, both of which lead to hypobaric hypoxia. While acute exposure may temporarily offset cardiovascular homeostasis in sea-level residents, native highlanders have become accustomed to these high-altitude conditions and often exhibit variations in normal ECG parameters. As part of the "Altitude Non-differentiated ECG Study" (ANDES) project, this paper aims to systematically review the available literature regarding ECG changes in healthy highlander populations. After searching the PubMed, Medline, and Embase databases, 286 abstracts were screened, of which 13 full-texts were ultimately included. This process was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Major ECG deviations in native healthy highlanders include right QRS axis deviation, right ventricular hypertrophy signs, and more prevalent T-wave inversion in the right precordial leads. Notably, they exhibit a prolonged QTc compared to sea-level residents, although within normal limits. Evidence about increased P-wave amplitude or duration, variations in PR interval, or greater prevalence of complete right bundle branch block is not conclusive. This review provides ECG reference standards that can be used by clinicians, who should be aware of the effects of high-altitude residence on cardiovascular health and how these may change according to age, ethnicity, and other factors.
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Affiliation(s)
- Josefina B Parodi
- Cardiology Division, CEMIC, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rashi Ramchandani
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Zier Zhou
- Atherosclerosis, Genomics and Vascular Biology Division, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Diego X Chango
- Cardiology and Advanced Cardiac Imaging Division, Hospital Universitario del Río, Cuenca, Azuay, Ecuador
| | - Rafael Acunzo
- Department of Medicine, University of Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Kiera Liblik
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada
| | - Juan M Farina
- Cardiovascular and Thoracic Surgery Department, Mayo Clinic, Phoenix, AZ, United States
| | - Ezequiel J Zaidel
- Cardiology Department, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
| | - Enrique Ruiz-Mori
- Cardiology Department, Instituto de Enfermedades neoplásicas, Lima, Peru
| | | | - Alvaro Sosa Liprandi
- Cardiology Department, Sanatorio Güemes, Ciudad Autónoma de Buenos Aires, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Kingston Health Sciences Center, Queen's University, Kingston, Ontario, Canada.
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19
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Yan J, Ruan P, Ge Y, Gao J, Tan H, Xiao C, Gao Q, Zhang Z, Gao Y. Mechanisms and Molecular Targets of Compound Danshen Dropping Pill for Heart Disease Caused by High Altitude Based on Network Pharmacology and Molecular Docking. ACS OMEGA 2021; 6:26942-26951. [PMID: 34693115 PMCID: PMC8529605 DOI: 10.1021/acsomega.1c03282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/21/2021] [Indexed: 05/30/2023]
Abstract
Compound Danshen dropping pill (CDDP), a famous Chinese medicine formula, has been widely used to treat high-altitude heart disease in China. However, its molecular mechanisms, potential targets, and bioactive ingredients remain elusive. In this study, network pharmacology, molecular docking, and validation experiments were combined to investigate the effective active ingredients and molecular mechanisms of CDDP in the treatment of high-altitude heart disease. Tan IIA may be the main active component of CDDP in the treatment of high-altitude heart disease via HIF-1/PI3K/Akt pathways.
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Affiliation(s)
- Jiayi Yan
- School
of Traditional Chinese Medicine, Guangdong
Pharmaceutical University, Guangzhou 510006, China
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
| | - Panpan Ruan
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
- School
of Life Science, Heibei University, Baoding 071000, China
| | - Yunxuan Ge
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
- College
of Life Science and Bioengineering, Beijing
University of Technology, Beijing 100124, China
| | - Jing Gao
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
- School
of Pharmacy, Henan University, Kaifeng 475004, China
| | - Hongling Tan
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
| | - Chengrong Xiao
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
| | - Quansheng Gao
- Institute
of Enviromental and Operational Medicine, Academy of Military Medical
Sciences, Academy of Military Sciences, Tianjin 300381, China
| | - Zhuo Zhang
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
| | - Yue Gao
- School
of Traditional Chinese Medicine, Guangdong
Pharmaceutical University, Guangzhou 510006, China
- Department
of Pharmaceutical Sciences, Beijing Institute
of Radiation Medicine, Beijing 100850, China
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20
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Schneider SR, Mayer LC, Lichtblau M, Berlier C, Schwarz EI, Saxer S, Tan L, Furian M, Bloch KE, Ulrich S. Effect of a day-trip to altitude (2500 m) on exercise performance in pulmonary hypertension: randomised crossover trial. ERJ Open Res 2021; 7:00314-2021. [PMID: 34651040 PMCID: PMC8502941 DOI: 10.1183/23120541.00314-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/21/2021] [Indexed: 11/20/2022] Open
Abstract
Question addressed by the study To investigate exercise performance and hypoxia-related health effects in patients with pulmonary hypertension (PH) during a high-altitude sojourn. Patients and methods In a randomised crossover trial in stable (same therapy for >4 weeks) patients with pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) with resting arterial oxygen tension (PaO2) ≥7.3 kPa, we compared symptom-limited constant work-rate exercise test (CWRET) cycling time during a day-trip to 2500 m versus 470 m. Further outcomes were symptoms, oxygenation and echocardiography. For safety, patients with sustained hypoxaemia at altitude (peripheral oxygen saturation <80% for >30 min or <75% for >15 min) received oxygen therapy. Results 28 PAH/CTEPH patients (n=15/n=13); 13 females; mean±sd age 63±15 years were included. After >3 h at 2500 m versus 470 m, CWRET-time was reduced to 17±11 versus 24±9 min (mean difference −6, 95% CI −10 to −3), corresponding to −27.6% (−41.1 to −14.1; p<0.001), but similar Borg dyspnoea scale. At altitude, PaO2 was significantly lower (7.3±0.8 versus 10.4±1.5 kPa; mean difference −3.2 kPa, 95% CI −3.6 to −2.8 kPa), whereas heart rate and tricuspid regurgitation pressure gradient (TRPG) were higher (86±18 versus 71±16 beats·min−1, mean difference 15 beats·min−1, 95% CI 7 to 23 beats·min−1) and 56±25 versus 40±15 mmHg (mean difference 17 mmHg, 95% CI 9 to 24 mmHg), respectively, and remained so until end-exercise (all p<0.001). The TRPG/cardiac output slope during exercise was similar at both altitudes. Overall, three (11%) out of 28 patients received oxygen at 2500 m due to hypoxaemia. Conclusion This randomised crossover study showed that the majority of PH patients tolerate a day-trip to 2500 m well. At high versus low altitude, the mean exercise time was reduced, albeit with a high interindividual variability, and pulmonary artery pressure at rest and during exercise increased, but pressure–flow slope and dyspnoea were unchanged. Short-time exposure to high altitude in pulmonary hypertension induces hypoxaemia, reduces constant work-rate cycle time compared to ambient air and is well tolerated overallhttps://bit.ly/3xUAFMs
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Affiliation(s)
- Simon R Schneider
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland.,Dept of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Laura C Mayer
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Charlotte Berlier
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Lu Tan
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Furian
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Clinic of Pulmonology, University Hospital of Zurich, Zurich, Switzerland
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21
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Forrer A, Scheiwiller PM, Mademilov M, Lichtblau M, Sheraliev U, Marazhapov NH, Saxer S, Bader P, Appenzeller P, Aydaralieva S, Muratbekova A, Sooronbaev TM, Ulrich S, Bloch KE, Furian M. Exercise Performance in Central Asian Highlanders: A Cross-Sectional Study. High Alt Med Biol 2021; 22:386-394. [PMID: 34432548 DOI: 10.1089/ham.2020.0211] [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] [Indexed: 11/12/2022] Open
Abstract
Forrer, Aglaia, Philipp M. Scheiwiller, Maamed Mademilov, Mona Lichtblau, Ulan Sheraliev, Nuriddin H. Marazhapov, Stéphanie Saxer, Patrick Bader, Paula Appenzeller, Shoira Aydaralieva, Aybermet Muratbekova, Talant M. Sooronbaev, Silvia Ulrich, Konrad E. Bloch, and Michael Furian. Exercise performance in central Asian highlanders: A cross-sectional study. High Alt Med Biol. 00:000-000, 2021. Introduction: Life-long exposure to hypobaric hypoxia induces physiologic adaptations in highlanders that may modify exercise performance; however, reference data for altitude populations are scant. Methods: Life-long residents of the Tien Shan mountain range, 2,500 - 3,500 m, Kyrgyzstan, free of cardiopulmonary disease, underwent cardiopulmonary cycle exercise tests with a progressive ramp protocol to exhaustion at 3,250 m. ECG, breath-by-breath pulmonary gas exchange, and oxygen saturation by pulse oximetry (SpO2) were measured. Results: Among 81 highlanders, age (mean ± SD) 48 ± 10 years, 46% women, SpO2 at rest was 88% ± 2%, peak oxygen uptake (V'O2peak) was 21.6 ± 5.9 mL/kg/min (76% ± 15% predicted for a low-altitude reference population); peak work rate (Wpeak) was 117 ± 37 W (77% ± 17% predicted), SpO2 at peak was 84% ± 5%, heart rate reserve (220 - age - maximal heart rate) was 28 ± 17/min, ventilatory reserve (maximal voluntary ventilation - maximal minute ventilation) was 68 ± 32 l/min, and respiratory exchange ratio was 1.03 ± 0.09. Peak BORG-CR10 dyspnea and leg fatigue scores were 5.1 ± 2.0 and 6.3 ± 2.1. In multivariable linear regression analyses, age and sex were robust determinants of Wpeak, V'O2peak, and metabolic equivalent (MET) at peak, whereas body mass index, resting systolic blood pressure, and mean pulmonary artery pressure were not. Conclusions: The current study shows that V'O2peak and Wpeak of highlanders studied at 3,250 m, near their altitude of residence, were reduced by about one quarter compared with mean predicted values for lowlanders. The provided prediction models for V'O2peak, Wpeak, and METs in central Asian highlanders might be valuable for comparisons with other high altitude populations.
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Affiliation(s)
- Aglaia Forrer
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Philipp M Scheiwiller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Maamed Mademilov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Mona Lichtblau
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Ulan Sheraliev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Nuriddin H Marazhapov
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Stéphanie Saxer
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Patrick Bader
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Paula Appenzeller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Shoira Aydaralieva
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Aybermet Muratbekova
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Talant M Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic.,Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland.,Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
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22
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Ulrich S, Saxer S, Furian M, Bader PR, Appenzeller P, Scheiwiller PM, Mademilov M, Sheraliev U, Tanner F, Sooronbaev TM, Bloch KE, Lichtblau M. Pulmonary haemodynamic response to exercise in highlanders versus lowlanders. ERJ Open Res 2021; 7:00937-2020. [PMID: 33834057 PMCID: PMC8021810 DOI: 10.1183/23120541.00937-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022] Open
Abstract
The aim of the study was to investigate the pulmonary haemodynamic response to exercise in Central Asian high- and lowlanders. This was a cross-sectional study in Central Asian highlanders (living >2500 m) compared with lowlanders (living <800 m), assessing cardiac function, including tricuspid regurgitation pressure gradient (TRPG), cardiac index and tricuspid annular plane systolic excursion (TAPSE) by echocardiography combined with heart rate and oxygen saturation measured by pulse oximetry (SpO2) during submaximal stepwise cycle exercise (10 W increase per 3 min) at their altitude of residence (at 760 m or 3250 m, respectively). 52 highlanders (26 females; aged 47.9±10.7 years; body mass index (BMI) 26.7±4.6 kg·m−2; heart rate 75±11 beats·min−1; SpO2 91±5%;) and 22 lowlanders (eight females; age 42.3±8.0 years; BMI 26.9±4.1 kg·m−2; heart rate 68±7 beats·min−1; SpO2 96±1%) were studied. Highlanders had a lower resting SpO2 compared to lowlanders but change during exercise was similar between groups (highlanders versus lowlanders −1.4±2.9% versus −0.4±1.1%, respectively, p=0.133). Highlanders had a significantly elevated TRPG and exercise-induced increase was significantly higher (13.6±10.5 mmHg versus 6.1±4.8 mmHg, difference 7.5 (2.8 to 12.2) mmHg; p=0.002), whereas cardiac index increase was slightly lower in highlanders (2.02±0.89 L·min−1versus 1.78±0.61 L·min−1, difference 0.24 (−0.13 to 0.61) L·min−1; p=0.206) resulting in a significantly steeper pressure–flow ratio (ΔTRPG/Δcardiac index) in highlanders 9.4±11.4 WU and lowlanders 3.0±2.4 WU (difference 6.4 (1.4 to 11.3) WU; p=0.012). Right ventricular-arterial coupling (TAPSE/TRPG) was significantly lower in highlanders but no significant difference in change with exercise in between groups was detected (−0.01 (−0.20 to 0.18); p=0.901). In highlanders, chronic exposure to hypoxia leads to higher pulmonary artery pressure and a steeper pressure–flow relation during exercise. Central Asian highlanders living between 2500 and 3600 m assessed by stress echocardiography showed that chronic exposure to hypoxia leads to a steeper pressure–flow curve during exercise and worse right ventricular–arterial coupling compared to lowlandershttps://bit.ly/3qlvhOj
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Affiliation(s)
- Silvia Ulrich
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,These authors contributed equally
| | - Stéphanie Saxer
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.,These authors contributed equally
| | - Michael Furian
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Patrick R Bader
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Paula Appenzeller
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Maamed Mademilov
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Ulan Sheraliev
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Felix Tanner
- Dept of Cardiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Konrad E Bloch
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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23
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Lichtblau M, Bader PR, Carta AF, Furian M, Muralt L, Saxer S, Hartmann SE, Rawling JM, Poulin MJ, Bloch KE, Ulrich S. Extravascular lung water and cardiac function assessed by echocardiography in healthy lowlanders during repeated very high-altitude exposure. Int J Cardiol 2021; 332:166-174. [PMID: 33775791 DOI: 10.1016/j.ijcard.2021.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND High-altitude pulmonary edema is associated with elevated systolic pulmonary artery pressure (sPAP) and increased extravascular lung water (EVLW). We investigated sPAP and EVLW during repeated exposures to high altitude (HA). METHODS Healthy lowlanders underwent two identical 7-day HA-cycles, where subjects slept at 2900 m and spent 4-8 h daily at 5050 m, separated by a weeklong break at low altitude (LA). Echocardiography and EVLW by B-lines were measured at 520 m (baseline, LA1), on day one, two and six at 5050 m (HA1-3) and after descent (LA2). RESULTS We included 21 subjects (median 25 years, body mass index 22 kg/m2, SpO2 98%). SPAP rose from 21 mmHg at LA1 to 38 mmHg at HA1, decreased to 30 mmHg at HA3 (both p < 0.05 vs LA1) and normalized at 20 mmHg at LA2 (p = ns vs LA1). B-lines increased from 0 at LA1 to 6 at HA2 and 7 at HA3 (both p < 0.05 vs LA1) and receded to 1 at LA2 (p = ns vs LA1). Overall, in cycle two, sPAP did not differ (mean difference (95% confidence interval) -0.2(-2.3 to 1.9) mmHg, p = 0.864) but B-lines were more prevalent (+2.3 (1.4-3.1), p < 0.001) compared to cycle 1. Right ventricular systolic function decreased significantly but minimally at 5050 m. CONCLUSIONS Exposure to 5050 m induced a rapid increase in sPAP. B-lines rose during prolonged exposures to 5050 m, despite gradual decrease in sPAP, indicating excessive hydrostatic pressure might not be solely responsible for EVLW-development. Repeated HA-exposure had no acclimatization effect on EVLW. This may affect workers needing repetitive ascents to altitude and could indicate greater B-line development upon repeated exposure.
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Affiliation(s)
- Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Patrick R Bader
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Arcangelo F Carta
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Lara Muralt
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Sara E Hartmann
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Jean M Rawling
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Marc J Poulin
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
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24
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Furian M, Latshang TD, Aeschbacher SS, Sheraliev U, Marazhapov NH, Mirrakhimov E, Ulrich S, Sooronbaev TM, Bloch KE. Markers of cardiovascular risk and their reversibility with acute oxygen therapy in Kyrgyz highlanders with high altitude pulmonary hypertension. Pulmonology 2021; 27:394-402. [PMID: 33674243 DOI: 10.1016/j.pulmoe.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND High altitude pulmonary hypertension (HAPH), a chronic altitude related illness, is associated with hypoxemia, dyspnea and reduced exercise performance. We evaluated ECG and pulse wave-derived markers of cardiovascular risk in highlanders with HAPH (HAPH+) in comparison to healthy highlanders (HH) and lowlanders (LL) and the effects of hyperoxia. METHODS We studied 34 HAPH+ and 54 HH at Aksay (3250m), and 34 LL at Bishkek (760m), Kyrgyzstan. Mean pulmonary artery pressure by echocardiography was mean±SD 34±3, 22±5, 16±4mmHg, respectively (p<0.05 all comparisons). During quiet rest, breathing room air or oxygen in randomized order, we measured heart-rate adjusted QT interval (QTc), an ECG-derived marker of increased cardiovascular mortality, and arterial stiffness index (SI), a marker of cardiovascular disease derived from pulse oximetry plethysmograms. RESULTS Pulse oximetry in HAPH+, HH and LL was, mean±SD, 88±4, 92±2 and 95±2%, respectively (p<0.05 vs HAPH+, both comparisons). QTc in HAPH+, HH and LL was 422±24, 405±27, 400±28ms (p<0.05 HAPH+ vs. others); corresponding SI was 10.5±1.9, 8.4±2.6, 8.5±2.0m/s, heart rate was 75±8, 68±8, 70±10 bpm (p<0.05, corresponding comparisons HAPH+ vs. others). In regression analysis, HAPH+ was an independent predictor of increased QTc and SI when controlled for several confounders. Oxygen breathing increased SI in HH but not in HAPH+, and reduced QTc in all groups. CONCLUSIONS Our data suggest that HAPH+ but not HH may be at increased risk of cardiovascular mortality and morbidity compared to LL. The lack of a further increase of the elevated SI during hyperoxia in HAPH+ may indicate dysfunctional control of vascular tone and/or remodelling.
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Affiliation(s)
- M Furian
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - T D Latshang
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - S S Aeschbacher
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - U Sheraliev
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - N H Marazhapov
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - E Mirrakhimov
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - S Ulrich
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - T M Sooronbaev
- National Center for Cardiology and Internal Medicine, Department of Respiratory Medicine, 3 Togolok Moldo Str., Bishkek 720040, Kyrgyzstan
| | - K E Bloch
- Pulmonary Division and Sleep Disorders Center, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
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25
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Aeschbacher SS, Latshang TD, Sheraliev U, Marazhapov NH, Ulrich S, Sooronbaev TM, Bloch KE, Furian M. Altered cardiac repolarisation in highlanders with high-altitude pulmonary hypertension during wakefulness and sleep. J Sleep Res 2020; 30:e13153. [PMID: 32776394 DOI: 10.1111/jsr.13153] [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: 05/27/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 11/27/2022]
Abstract
High-altitude pulmonary hypertension (HAPH) is an altitude-related illness associated with hypoxaemia that may promote sympathetic excitation and prolongation of the QT interval. The present case-control study tests whether QT intervals, markers of malignant cardiac arrhythmias, are prolonged in highlanders with HAPH (HAPH+) compared to healthy highlanders (HH) and healthy lowlanders (LL). The mean pulmonary artery pressure (mPAP) was measured by echocardiography in 18 HAPH+ (mPAP, 34 mmHg) and 18 HH (mPAP, 23 mmHg) at 3,250 m, and 18 LL (mPAP, 18 mmHg) at 760 m, Kyrgyzstan (p < .05 all mPAP comparisons). Groups were matched for age, sex and body mass index. Electrocardiography and pulse oximetry were continuously recorded during nocturnal polysomnography. The heart rate-adjusted QT interval, QTc, was averaged over consecutive 1-min periods. Overall, a total of 26,855 averaged 1-min beat-by-beat periods were semi-automatically analysed. In HAPH+, maximum nocturnal QTc was longer during sleep (median 456 ms) than wakefulness (432 ms, p < .05) and exceeded corresponding values in HH (437 and 419 ms) and LL (430 and 406 ms), p < .05, respectively. The duration of night-time QTc >440 ms was longer in HAPH+ (median 144 min) than HH and LL (46 and 14 min, p < .05, respectively). HAPH+ had higher night-time heart rate (median 78 beats/min) than HH and LL (66 and 65 beats/min, p < .05, respectively), lower mean nocturnal oxygen saturation than LL (88% versus 95%, p < .05) and more cyclic oxygen desaturations (median 24/hr) than HH and LL (13 and 3/hr, p < .05, respectively). In conclusion, HAPH was associated with higher night-time heart rate, hypoxaemia and longer QTc versus HH and LL, and may represent a substrate for increased risk of malignant cardiac arrhythmias.
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Affiliation(s)
- Sayaka S Aeschbacher
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Tsogyal D Latshang
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Ulan Sheraliev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nuriddin H Marazhapov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Silvia Ulrich
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Talant M Sooronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
| | - Michael Furian
- Department of Respiratory Medicine, Sleep Disorders Center, University Hospital of Zurich, Zurich, Switzerland
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