1
|
Gatterer H, Villafuerte FC, Ulrich S, Bhandari SS, Keyes LE, Burtscher M. Altitude illnesses. Nat Rev Dis Primers 2024; 10:43. [PMID: 38902312 DOI: 10.1038/s41572-024-00526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2024] [Indexed: 06/22/2024]
Abstract
Millions of people visit high-altitude regions annually and more than 80 million live permanently above 2,500 m. Acute high-altitude exposure can trigger high-altitude illnesses (HAIs), including acute mountain sickness (AMS), high-altitude cerebral oedema (HACE) and high-altitude pulmonary oedema (HAPE). Chronic mountain sickness (CMS) can affect high-altitude resident populations worldwide. The prevalence of acute HAIs varies according to acclimatization status, rate of ascent and individual susceptibility. AMS, characterized by headache, nausea, dizziness and fatigue, is usually benign and self-limiting, and has been linked to hypoxia-induced cerebral blood volume increases, inflammation and related trigeminovascular system activation. Disruption of the blood-brain barrier leads to HACE, characterized by altered mental status and ataxia, and increased pulmonary capillary pressure, and related stress failure induces HAPE, characterized by dyspnoea, cough and exercise intolerance. Both conditions are progressive and life-threatening, requiring immediate medical intervention. Treatment includes supplemental oxygen and descent with appropriate pharmacological therapy. Preventive measures include slow ascent, pre-acclimatization and, in some instances, medications. CMS is characterized by excessive erythrocytosis and related clinical symptoms. In severe CMS, temporary or permanent relocation to low altitude is recommended. Future research should focus on more objective diagnostic tools to enable prompt treatment, improved identification of individual susceptibilities and effective acclimatization and prevention options.
Collapse
Affiliation(s)
- Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy.
- Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT TIROL-Private University for Health Sciences and Health Technology, Hall in Tirol, Austria.
| | - Francisco C Villafuerte
- Laboratorio de Fisiología del Transporte de Oxígeno y Adaptación a la Altura - LID, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sanjeeb S Bhandari
- Mountain Medicine Society of Nepal, Kathmandu, Nepal
- Emergency Department, UPMC Western Maryland Health, Cumberland, MD, USA
| | - Linda E Keyes
- Department of Emergency Medicine, University of Colorado, Aurora, CO, USA
| | - Martin Burtscher
- Department of Sport Science, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
2
|
Champigneulle B, Stauffer E, Robach P, Doutreleau S, Howe CA, Pina A, Salazar-Granara AA, Hancco I, Guergour D, Brugniaux JV, Connes P, Pichon A, Verges S. Early effects of acetazolamide on hemoglobin mass and plasma volume in chronic mountain sickness at 5100 m. Pulmonology 2023:S2531-0437(23)00095-8. [PMID: 37263861 DOI: 10.1016/j.pulmoe.2023.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Chronic Mountain Sickness (CMS) syndrome, combining excessive erythrocytosis and clinical symptoms in highlanders, remains a public health concern in high-altitude areas, especially in the Andes, with limited therapeutic approaches. The objectives of this study were to assess in CMS-highlanders permanently living in La Rinconada (5100-5300 m, Peru, the highest city in the world), the early efficacy of acetazolamide (ACZ) and atorvastatin to reduce hematocrit (Hct), as well as the underlying mechanisms focusing on intravascular volumes. MATERIALS AND METHODS Forty-one males (46±8 years of age) permanently living in La Rinconada for 15 [10-20] years and suffering from CMS were randomized between ACZ (250 mg once-daily; N = 13), atorvastatin (20 mg once-daily; N = 14) or placebo (N = 14) uptake in a double-blinded parallel study. Hematocrit (primary endpoint) as well as arterial blood gasses, total hemoglobin mass (Hbmass) and intravascular volumes were assessed at baseline and after a mean (±SD) treatment duration of 19±2 days. RESULTS ACZ increased PaO2 by +13.4% (95% CI: 4.3 to 22.5%) and decreased Hct by -5.2% (95% CI: -8.3 to -2.2%), whereas Hct remained unchanged with placebo or atorvastatin. ACZ tended to decrease Hbmass (-2.6%, 95% CI: -5.7 to 0.5%), decreased total red blood cell volume (RBCV, -5.3%, 95% CI: -10.3 to -0.3%) and increased plasma volume (PV, +17.6%, 95% CI: 4.9 to 30.3%). Atorvastatin had no effect on intravascular volumes, while Hbmass and RBCV increased in the placebo group (+6.1%, 95% CI: 4.2 to 7.9% and +7.0%, 95%CI: 2.7 to 11.4%, respectively). CONCLUSIONS Short-term ACZ uptake was effective to reduce Hct in CMS-highlanders living at extreme altitude >5,000 m and was associated with both an increase in PV and a reduction in RBCV.
Collapse
Affiliation(s)
- B Champigneulle
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France.
| | - E Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France; Exploration Fonctionnelle Respiratoire, Médecine du Sport et de l'Activité Physique, Hospices Civils de Lyon, Hôpital Croix Rousse, Lyon, France
| | - P Robach
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France; National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France
| | - S Doutreleau
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - C A Howe
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, Canada
| | - A Pina
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, S. Luca Hospital, Milan, Italy
| | - A A Salazar-Granara
- Universidad de San Martin de Porres, School of Medicine, Research Centre in Altitude Medicine, Lima, Peru
| | - I Hancco
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - D Guergour
- Unité Biochimie Immunoanalyse, Service de Biochimie Biologie Moléculaire et Toxicologie Environnementale, Institut de Biologie et Pathologie, CHU Grenoble Alpes, France
| | - J V Brugniaux
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| | - P Connes
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Team "Vascular Biology and Red Blood Cell", Université Claude Bernard Lyon 1, Université de Lyon, France; Laboratoire d'Excellence du Globule Rouge (Labex GR-Ex), PRES Sorbonne, Paris, France
| | - A Pichon
- Laboratoire Move EA 6314, Faculté des Sciences du Sport, Universit. De Poitiers, Poitiers, France
| | - S Verges
- Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, HP2, 38000 Grenoble, France
| |
Collapse
|
3
|
Vizcardo-Galindo GA, Howe CA, Hoiland RL, Carter HH, Willie CK, Ainslie PN, Tremblay JC. Impact of Oxygen Supplementation on Brachial Artery Hemodynamics and Vascular Function During Ascent to 5,050 m. High Alt Med Biol 2023; 24:27-36. [PMID: 36940101 DOI: 10.1089/ham.2022.0107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023] Open
Abstract
Vizcardo-Galindo, Gustavo A., Connor A. Howe, Ryan L. Hoiland, Howard H. Carter, Christopher K. Willie, Philip N. Ainslie, and Joshua C. Tremblay. Impact of oxygen supplementation on brachial artery hemodynamics and vascular function during ascent to 5,050 m. High Alt Med Biol. 24:27-36, 2023.-High-altitude trekking alters upper limb hemodynamics and reduces brachial artery vascular function in lowlanders. Whether these changes are reversible with the removal of hypoxia is unknown. We investigated the impact of 20 minutes of oxygen supplementation (O2) on brachial artery hemodynamics, reactive hyperemia (RH; microvascular function), and flow-mediated dilation (FMD; endothelial function). Participants (aged 21-42 years) were examined before and with O2 at 3,440 m (n = 7), 4,371 m (n = 7), and 5,050 m (n = 12) using Duplex ultrasound (days 4, 7, and 10 respectively). At 3,440 m, O2 decreased brachial artery diameter (-5% ± 5%; p = 0.04), baseline blood flow (-44% ± 15%; p < 0.001), oxygen delivery (-39 ± 16; p < 0.001), and peak RH (-8% ± 8%; p = 0.02), but not RH normalized for baseline blood flow. Elevated FMD (p = 0.04) with O2 at 3,440 m was attributed to the reduction in baseline diameter. At 5,050 m, a reduction in brachial artery blood flow (-17% ± 22%; p = 0.03), but not oxygen delivery, diameter, RH, or FMD occurred with O2. These findings suggest that during early trekking at high altitude, O2 causes vasoconstriction in the upper limb along the arterial tree (conduit and resistance arteries). With incremental high-altitude exposure, O2 reduces blood flow without compromising oxygen delivery, RH, or FMD, suggesting a differential impact on vascular function modulated by the duration and severity of high-altitude exposure.
Collapse
Affiliation(s)
- Gustavo A Vizcardo-Galindo
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada
| | - Connor A Howe
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada
| | - Ryan L Hoiland
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, Vancouver General Hospital, University of British Columbia, Vancouver, Canada
- Department of Cellular and Physiological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, Vancouver, Canada
| | - Howard H Carter
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
- Cardiovascular Research Group, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia
| | - Christopher K Willie
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada
| | - Philip N Ainslie
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada
| | - Joshua C Tremblay
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada
| |
Collapse
|
4
|
Perger E, Baillieul S, Esteve F, Pichon A, Bilo G, Soranna D, Doutreleau S, Savina Y, Ulliel-Roche M, Brugniaux JV, Stauffer E, Oberholzer L, Howe C, Hannco I, Lombardi C, Tamisier R, Pepin JL, Verges S, Parati G. Nocturnal hypoxemia, blood pressure, vascular status and chronic mountain sickness in the highest city in the world. Ann Med 2022; 54:1884-1893. [PMID: 35786084 PMCID: PMC9258438 DOI: 10.1080/07853890.2022.2091791] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Chronic mountain sickness (CMS) is a condition characterized by excessive erythrocytosis in response to chronic hypobaric hypoxia. CMS frequently triggers cardiorespiratory diseases such as pulmonary hypertension and right or left heart failure. Ambient hypoxia might be further amplified night-time by intermittent hypoxia related to sleep-disordered breathing (SDB) so that sleep disturbance may be an important feature of CMS. Our aim was to characterize in a cross-sectional study nocturnal hypoxaemia, SDB, blood pressure (BP), arterial stiffness and carotid intima-media thickness (CIMT) in highlanders living at extreme altitude. METHODS Men aged 18 to 55 years were prospectively recruited. Home sleep apnoea test, questionnaires (short-form health survey; Montreal cognitive assessment; Pittsburgh Sleep Questionnaire Index and the Insomnia severity index), 24-h ambulatory BP monitoring, CIMT and arterial stiffness were evaluated in 3 groups: i) Andean lowlanders (sea-level); ii) highlanders living at 3,800 m and iii) highlanders living at 5,100 m. Analyses were conducted in sub-groups according to 1) CMS severity 2) healthy subjects living at the three different altitude. RESULTS Ninety-two males were evaluated at their living altitudes. Among the 54 highlanders living at 5,100 m, subjects with CMS showed lower mean nocturnal oxygen saturation (SpO2), SpO2 nadir, lower pulse wave velocity and higher nocturnal BP variability than those with no-CMS. Lower nocturnal SpO2 nadir was associated with higher CMS severity (ß= -0.14, p=.009). Among the 55 healthy subjects, healthy highlanders at 5,100 m were characterized by lower scores on quality of life and sleep quality scales and lower mean SpO2 compared to lowlanders. CONCLUSIONS Lower nocturnal SpO2 and higher nocturnal BP variability are associated with CMS severity in individuals living permanently at high altitude. The role of lower SpO2 and higher nocturnal BP variability in the cardiovascular progression of CMS and in the overall prognosis of the disease need to be evaluated in further studies.
Collapse
Affiliation(s)
- Elisa Perger
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
| | - Sébastien Baillieul
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - François Esteve
- Inserm UA7, Rayonnement Synchrotron pour la Recherche Biomédicale, Grenoble, France
| | - Aurélien Pichon
- Faculty of Sport Sciences, Université de Poitiers, Laboratory Mobility, aging & exercise (MOVE, EA6314), Poitiers, France
| | - Gzregorz Bilo
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
| | - Davide Soranna
- Istituto Auxologico Italiano, IRCCS, Biostatistics unit, Milan, Italy
| | - Stéphane Doutreleau
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Yann Savina
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Mathilde Ulliel-Roche
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Julien V Brugniaux
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Emeric Stauffer
- Interuniversity Laboratory of Human Movement Biology (LIBM, EA7424), "Red Blood cell and Vascular Biology" team, Univ Lyon - University Claude Bernard Lyon 1, Villeurbanne, France
| | - Laura Oberholzer
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Connor Howe
- Centre for Heart, Lung, and Vascular Health, University of British Columbia, Kelowna, Canada
| | - Ivan Hannco
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Carolina Lombardi
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
| | - Renaud Tamisier
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Louis Pepin
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Samuel Verges
- Univ. Grenoble Alpes, HP2 Laboratory, INSERM U1300, CHU Grenoble Alpes, Grenoble, France
| | - Gianfranco Parati
- Istituto Auxologico Italiano, IRCCS, Sleep Disorders Center & Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy.,Biostatistic Unit, University of Milano-Bicocca, Milan, Italy
| |
Collapse
|
5
|
Villafuerte FC, Simonson TS, Bermudez D, León-Velarde F. High-Altitude Erythrocytosis: Mechanisms of Adaptive and Maladaptive Responses. Physiology (Bethesda) 2022; 37:0. [PMID: 35001654 PMCID: PMC9191173 DOI: 10.1152/physiol.00029.2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Erythrocytosis, or increased production of red blood cells, is one of the most well-documented physiological traits that varies within and among in high-altitude populations. Although a modest increase in blood O2-carrying capacity may be beneficial for life in highland environments, erythrocytosis can also become excessive and lead to maladaptive syndromes such as chronic mountain sickness (CMS).
Collapse
Affiliation(s)
- Francisco C. Villafuerte
- 1Laboratorio de Fisiología Comparada/Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Tatum S. Simonson
- 2Division of Pulmonary, Critical Care, and Sleep Medicine, School of Medicine, University of California, San Diego, La Jolla, California
| | - Daniela Bermudez
- 1Laboratorio de Fisiología Comparada/Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Fabiola León-Velarde
- 1Laboratorio de Fisiología Comparada/Laboratorio de Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| |
Collapse
|
6
|
Prevalence of hypertension and its relationship with altitude in highland areas: a systematic review and meta-analysis. Hypertens Res 2022; 45:1225-1239. [PMID: 35705740 DOI: 10.1038/s41440-022-00955-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
This systematic review and meta-analysis synthesized the pooled prevalence of hypertension at high altitudes and explored its correlation with altitude using studies published in Chinese and English from database inception to February 2021. A systematic literature search was conducted among bibliographic databases (PubMed, Embase, and Web of Science) and three Chinese databases (CNKI, VIP, and Wanfang data) to identify eligible studies. A random-effects model was used to calculate the overall pooled prevalence of hypertension. The I2 statistic was used to assess heterogeneity across studies. Random-effects meta-regression was conducted to investigate covariates that may have influenced between-study heterogeneity. The pooled prevalence of hypertension among the general population in high-altitude areas was 33.0% (95% CI: 29.0-38.0%), with high between-study heterogeneity (I2 = 99.4%, P < 0.01). Subgroup analyses showed the pooled prevalence of hypertension in Tibetan individuals was significantly higher than that in non-Tibetan individuals living in the Himalayas and Pamir Mountains (41% vs. 18%). A trend toward an increase in the prevalence of hypertension was found with every 100-m increase in elevation (coefficient: 0.012, 95% CI: -0.001 to 0.025, P = 0.069) only in Tibetan individuals. In addition, in these individuals, we found an increase in mean diastolic BP with each 100-m increase in altitude (coefficient: 0.763, 95% CI: 0.122-1.403, P = 0.025). Our meta-analysis suggests that the pooled prevalence of hypertension among the general population in high-altitude areas is 33.0%. Subjects of Tibetan ethnicity were more prone to developing hypertension at high altitudes. However, a very weak relationship between altitude and the prevalence of hypertension was found only in Tibetan individuals.
Collapse
|
7
|
Schmidt WFJ, Wachsmuth N, Jimenez J, Soria R. Hemoglobin Mass and Blood Volume in Patients With Altitude-Related Polycythemia. Front Physiol 2022; 13:867108. [PMID: 35574463 PMCID: PMC9096560 DOI: 10.3389/fphys.2022.867108] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with chronic mountain sickness (CMS) have a high hemoglobin concentration [Hb] due to increased hemoglobin mass (Hbmass) and possibly reduced plasma volume (PV). The values of Hbmass, PV and blood volume (BV) have been described differently, and the relationships between [Hb] and Hbmass or PV are poorly understood. This study obtained representative Hbmass, PV and BV data from healthy, high-altitude residents and CMS patients and quantified the dependency of [Hb] on Hbmass and PV. METHODS Eighty-seven subjects born at high altitude (∼3,900 m) were enrolled. Thirty-four had CMS (CMS), 11 had polycythemia without CMS (intermediate, IM), 20 were healthy highlanders (HH), and 22 living near sea level (SL, 420 m) served as the sea level (SL) control group. Hbmass, PV and BV were determined using a CO-rebreathing method modified for assessing polycythemia patients. Furthermore, [Hb], hematocrit (Hct), plasma erythropoietin concentration [EPO] and blood gas and acid-base status were determined. RESULTS In the HH group, Hbmass was 27% higher (940 ± 105 g) than in the SL group (740 ± 112 g) and 72% (1,617 ± 265 g) lower than in the CMS group. The PV in the HH group was similar to that in the SL group (-6%) and 15% higher than that in the CMS group (p < 0.001). In the HH group, the BV (5,936 ± 673 ml) did not differ from that in the SL group and was 28% lower than in the CMS group (7,606 ± 1075 ml, p < 0.001). Log [EPO] was slightly increased in the CMS group relative to the HH group (p < 0.01). All values in the IM group were between those in the HH and CMS groups. Hbmass and BV were positively correlated, and PV was negatively correlated with peripheral O2 saturation. Increased Hbmass and decreased PV contributed approximately 65 and 35%, respectively, to the difference in [Hb] between the HH (17.1 ± 0.8 g/dl) and CMS (22.1 ± 1.0 g/dl) groups. CONCLUSIONS In CMS patients, the decrease in PV only partially compensated for the substantial increase in Hbmass, but it did not prevent an increase in BV; the decrease in PV contributed to an excessively high [Hb].
Collapse
Affiliation(s)
- Walter F J Schmidt
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Nadine Wachsmuth
- Department of Sports Medicine and Sports Physiology, University of Bayreuth, Bayreuth, Germany
| | - Jesus Jimenez
- Instituto Boliviano de Biologia de Altura, Universidad Mayor de San Andres, La Paz, Bolivia
| | - Rudy Soria
- Instituto Boliviano de Biologia de Altura, Universidad Mayor de San Andres, La Paz, Bolivia
| |
Collapse
|
8
|
Bailey DM, Culcasi M, Filipponi T, Brugniaux JV, Stacey BS, Marley CJ, Soria R, Rimoldi SF, Cerny D, Rexhaj E, Pratali L, Salmòn CS, Jáuregui CM, Villena M, Villafuerte F, Rockenbauer A, Pietri S, Scherrer U, Sartori C. EPR spectroscopic evidence of iron-catalysed free radical formation in chronic mountain sickness: Dietary causes and vascular consequences. Free Radic Biol Med 2022; 184:99-113. [PMID: 35398201 DOI: 10.1016/j.freeradbiomed.2022.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/24/2022] [Accepted: 03/29/2022] [Indexed: 12/12/2022]
Abstract
Chronic mountain sickness (CMS) is a high-altitude (HA) maladaptation syndrome characterised by elevated systemic oxidative-nitrosative stress (OXNOS) due to a free radical-mediated reduction in vascular nitric oxide (NO) bioavailability. To better define underlying mechanisms and vascular consequences, this study compared healthy male lowlanders (80 m, n = 10) against age/sex-matched highlanders born and bred in La Paz, Bolivia (3600 m) with (CMS+, n = 10) and without (CMS-, n = 10) CMS. Cephalic venous blood was assayed using electron paramagnetic resonance spectroscopy and reductive ozone-based chemiluminescence. Nutritional intake was assessed via dietary recall. Systemic vascular function and structure were assessed via flow-mediated dilatation, aortic pulse wave velocity and carotid intima-media thickness using duplex ultrasound and applanation tonometry. Basal systemic OXNOS was permanently elevated in highlanders (P = <0.001 vs. lowlanders) and further exaggerated in CMS+, reflected by increased hydroxyl radical spin adduct formation (P = <0.001 vs. CMS-) subsequent to liberation of free 'catalytic' iron consistent with a Fenton and/or nucleophilic addition mechanism(s). This was accompanied by elevated global protein carbonylation (P = 0.046 vs. CMS-) and corresponding reduction in plasma nitrite (P = <0.001 vs. lowlanders). Dietary intake of vitamins C and E, carotene, magnesium and retinol were lower in highlanders and especially deficient in CMS + due to reduced consumption of fruit and vegetables (P = <0.001 to 0.028 vs. lowlanders/CMS-). Systemic vascular function and structure were also impaired in highlanders (P = <0.001 to 0.040 vs. lowlanders) with more marked dysfunction observed in CMS+ (P = 0.035 to 0.043 vs. CMS-) in direct proportion to systemic OXNOS (r = -0.692 to 0.595, P = <0.001 to 0.045). Collectively, these findings suggest that lifelong exposure to iron-catalysed systemic OXNOS, compounded by a dietary deficiency of antioxidant micronutrients, likely contributes to the systemic vascular complications and increased morbidity/mortality in CMS+. TRIAL REGISTRY: ClinicalTrials.gov; No: NCT01182792; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK.
| | - Marcel Culcasi
- Aix Marseille Univ, CNRS, ICR, UMR, 7273, Marseille, France
| | - Teresa Filipponi
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
| | - Julien V Brugniaux
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK; HP2 Laboratory, INSERM U1300, Grenoble Alpes University, Grenoble, France
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
| | - Christopher J Marley
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Wales, UK
| | - Rodrigo Soria
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | - Stefano F Rimoldi
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | - David Cerny
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | - Emrush Rexhaj
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland
| | | | | | | | | | - Francisco Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antal Rockenbauer
- Institute of Materials and Environmental Chemistry, Research Center for Natural Sciences, 1117, Budapest, Hungary
| | - Sylvia Pietri
- Aix Marseille Univ, CNRS, ICR, UMR, 7273, Marseille, France
| | - Urs Scherrer
- Department of Cardiology and Biomedical Research, University Hospital, Bern, Switzerland; Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile
| | - Claudio Sartori
- Department of Internal Medicine, University Hospital, UNIL-Lausanne, Switzerland
| |
Collapse
|
9
|
Stone RM, Ainslie PN, Tremblay JC, Akins JD, MacLeod DB, Tymko MM, DeSouza CA, Bain AR. GLOBAL REACH 2018: intra-arterial vitamin C improves endothelial-dependent vasodilatory function in humans at high altitude. J Physiol 2021; 600:1373-1383. [PMID: 34743333 DOI: 10.1113/jp282281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/11/2021] [Indexed: 12/20/2022] Open
Abstract
High altitude-induced hypoxaemia is often associated with peripheral vascular dysfunction. However, the basic mechanism(s) underlying high-altitude vascular impairments remains unclear. This study tested the hypothesis that oxidative stress contributes to the impairments in endothelial function during early acclimatization to high altitude. Ten young healthy lowlanders were tested at sea level (344 m) and following 4-6 days at high altitude (4300 m). Vascular endothelial function was determined using the isolated perfused forearm technique with forearm blood flow (FBF) measured by strain-gauge venous occlusion plethysmography. FBF was quantified in response to acetylcholine (ACh), sodium nitroprusside (SNP) and a co-infusion of ACh with the antioxidant vitamin C (ACh+VitC). The total FBF response to ACh (area under the curve) was ∼30% lower at high altitude than at sea level (P = 0.048). There was no difference in the response to SNP at high altitude (P = 0.860). At sea level, the co-infusion of ACh+VitC had no influence on the FBF dose response (P = 0.268); however, at high altitude ACh+VitC resulted in an average increase in the FBF dose response by ∼20% (P = 0.019). At high altitude, the decreased FBF response to ACh, and the increase in FBF in response to ACh+VitC, were associated with the magnitude of arterial hypoxaemia (R2 = 0.60, P = 0.008 and R2 = 0.63, P = 0.006, respectively). Collectively, these data support the hypothesis that impairments in vascular endothelial function at high altitude are in part attributable to oxidative stress, a consequence of the magnitude of hypoxaemia. These data extend our basic understanding of vascular (mal)adaptation to high-altitude sojourns, with important implications for understanding the aetiology of high altitude-related vascular dysfunction. KEY POINTS: Vascular dysfunction has been demonstrated in lowlanders at high altitude (>4000 m). However, the extent of impairment and the delineation of contributing mechanisms have remained unclear. Using the gold-standard isolated perfused forearm model, we determined the extent of vasodilatory dysfunction and oxidative stress as a contributing mechanism in healthy lowlanders before and 4-6 days after rapid ascent to 4300 m. The total forearm blood flow response to acetylcholine at high altitude was decreased by ∼30%. Co-infusion of acetylcholine with the antioxidant vitamin C partially restored the total forearm blood flow by ∼20%. The magnitude of forearm blood flow reduction, as well as the impact of oxidative stress, was positively associated with the individual severity of hypoxaemia. These data extend our basic understanding of vascular (mal)adaptation to high-altitude sojourns, with important implications for understanding the aetiology of high altitude-related changes in endothelial-mediated vasodilatory function.
Collapse
Affiliation(s)
- Rachel M Stone
- Faculty of Human Kinetics, University of Windsor, Ontario, Canada
| | - Philip N Ainslie
- Kelowna, Centre for Heart Lung and Vascular Health, University of British Columbia, Vancouver, Canada
| | - Joshua C Tremblay
- Kelowna, Centre for Heart Lung and Vascular Health, University of British Columbia, Vancouver, Canada
| | | | - David B MacLeod
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | | | - Anthony R Bain
- Faculty of Human Kinetics, University of Windsor, Ontario, Canada
| |
Collapse
|
10
|
Garrido E, Botella de Maglia J, Castillo O. Acute, subacute and chronic mountain sickness. Rev Clin Esp 2021; 221:481-490. [PMID: 34583826 DOI: 10.1016/j.rceng.2019.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
More than 100 million people ascend to high mountainous areas worldwide every year. At nonextreme altitudes (<5500m), 10-85% of these individuals are affected by acute mountain sickness, the most common disease induced by mild-moderate hypobaric hypoxia. Approximately 140 million individuals live permanently at heights of 2500-5500m, and up to 10% of them are affected by the subacute form of mountain sickness (high-altitude pulmonary hypertension) or the chronic form (Monge's disease), the latter of which is especially common in Andean ethnicities. This review presents the most relevant general concepts of these 3 clinical variants, which can be incapacitating and can result in complications and become life-threatening. Proper prevention, diagnosis, treatment and management of these conditions in a hostile environment such as high mountains are therefore essential.
Collapse
Affiliation(s)
- E Garrido
- Servicio de Hipobaria y Fisiología Biomédica, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Instituto de Estudios de Medicina de Montaña (IEMM), Barcelona, Spain.
| | - J Botella de Maglia
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Estudios de Medicina de Montaña (IEMM), Barcelona, Spain
| | - O Castillo
- Instituto Nacional de Biología Andina, Universidad Nacional Mayor de San Marcos, Lima, Peru
| |
Collapse
|
11
|
Coombs GB, Akins JD, Patik JC, Vizcardo-Galindo GA, Figueroa-Mujica R, Tymko MM, Stacey BS, Iannetelli A, Bailey DM, Villafuerte FC, Ainslie PN, Brothers RM. Global Reach 2018: Nitric oxide-mediated cutaneous vasodilation is reduced in chronic, but not acute, hypoxia independently of enzymatic superoxide formation. Free Radic Biol Med 2021; 172:451-458. [PMID: 34129928 DOI: 10.1016/j.freeradbiomed.2021.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/23/2021] [Accepted: 06/06/2021] [Indexed: 01/15/2023]
Abstract
We tested the hypotheses that 1) cutaneous microvascular function is impaired by acute normobaric and chronic hypobaric hypoxia and 2) that the superoxide free radical (via NADPH oxidase or xanthine oxidase) contributes to this impairment via nitric oxide (NO) scavenging. Local heating-induced cutaneous hyperemia (39 °C) was measured in the forearm of 11 male lowlanders at sea level (SL) and following 14-18 days at high altitude (HA; 4340 m in Cerro de Pasco, Peru), and compared to 11 highlanders residing permanently at this elevation. Cutaneous vascular conductance (CVC; laser-Doppler flux/mean arterial pressure) was not different during 39 °C [control site: 73 (19) vs. 71 (18)%max; P = 0.68] between normoxia and acute normobaric hypoxia (FIO2 = 0.125; equivalent to HA), respectively. At HA, CVC was reduced during 39 °C in lowlanders compared to SL [control site: 54 (14) vs. 73 (19)%max; P < 0.01] and was lower in Andean highlanders compared to lowlanders at HA [control site: 50 (24) vs. 54 (14)%max; P = 0.02]. The NO contribution to vasodilation during 39 °C (i.e., effect of NO synthase inhibition) was reduced in lowlanders at HA compared to SL [control site: 41 (11) vs 49 (10)%max; P = 0.04] and in Andean highlanders compared to lowlanders at HA [control site: 32 (21) vs. 41 (11)%max; P = 0.01]. Intradermal administration (cutaneous microdialysis) of the superoxide mimetic Tempol, inhibition of xanthine oxidase (via allopurinol), or NADPH oxidase (via apocynin) had no influence on cutaneous endothelium-dependent dilation during any of the conditions (all main effects of drug P > 0.05). These results suggest that time at HA impairs NO-mediated cutaneous vasodilation independent of enzymatic superoxide formation.
Collapse
Affiliation(s)
- Geoff B Coombs
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; School of Kinesiology, University of Western Ontario, London, ON, Canada
| | - John D Akins
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA
| | - Jordan C Patik
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA; Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA
| | - Gustavo A Vizcardo-Galindo
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Romulo Figueroa-Mujica
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Michael M Tymko
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada; Neurovascular Health Laboratory, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Angelo Iannetelli
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, United Kingdom
| | - Francisco C Villafuerte
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - R Matthew Brothers
- Department of Kinesiology, University of Texas at Arlington, Arlington, TX, USA.
| |
Collapse
|
12
|
A 1H NMR spectroscopic metabolomic study of the protective effects of irbesartan in a rat model of chronic mountain sickness. J Pharm Biomed Anal 2021; 204:114235. [PMID: 34252817 DOI: 10.1016/j.jpba.2021.114235] [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: 03/25/2021] [Revised: 06/14/2021] [Accepted: 06/29/2021] [Indexed: 11/22/2022]
Abstract
Chronic mountain sickness (CMS) is a significant pathology in most high-altitude regions globally, affecting the cardiopulmonary system and its mechanism is largely unknown. A metabonomic approach using 1H nuclear magnetic resonance spectroscopy allows for detecting differential metabolites, which provides a global view and mechanisms during CMS development. In this study, we simulated a high-altitude environment to establish a rat model of CMS. Irbesartan was administered to CMS rats at three doses (6.75, 13.5, and 27 mg/kg) once a day for 15 days. HE staining and transmission electron microscopy were used to evaluate the effect of changes on the lung. Based on 1H NMR spectra obtained from serum samples, partial least squares-discriminant analysis (PLS-DA) and its variant orthogonal PLS-DA (OPLS-DA) models were applied to distinguish the different groups. Histopathological sections showed that the alveolar structure was abnormal, inflammatory infiltration occurred in CMS rats, and CMS induced notable metabolic disorder according to the 1H NMR result. However, irbesartan reversed the imbalanced metabolites via energy metabolism, amino acid metabolism, and taurine metabolism pathways, and its effect was also confirmed by the general signs and morphology of the lung. The results revealed that irbesartan as an effective therapeutic agent to improve CMS is warranted.
Collapse
|
13
|
Nijiati Y, Yang T, Aimaiti M, Maimaitiyiming D, Aikemu A. Irbesartan ameliorates chronic mountain sickness in a rat model via the cholesterol metabolism: An iTRAQ -based proteomics analysis. Biomed Pharmacother 2021; 141:111802. [PMID: 34147903 DOI: 10.1016/j.biopha.2021.111802] [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: 03/24/2021] [Revised: 05/31/2021] [Accepted: 06/07/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To study the effects of irbesartan on pulmonary artery lesions in a rat model with chronic mountain sickness (CMS) and identify the biomarkers involved. METHODS In this study, we used a rat model of CMS to evaluate the therapeutic effect of irbesartan by measuring pulmonary artery pressure and evaluating the histopathology of the pulmonary artery. We also used proteomics technology to identify differentially expressed proteins (DEPs) in the serum and performed bioinformatics analysis. Results were then verified by enzyme linked immunosorbent assay (ELISA) and immunohistochemistry (IHC). RESULTS Irbesartan treatment induced a significant decrease (P < 0.05) in the pulmonary artery pressure of CMS rats. Histopathological and electron microscope further confirmed that high altitude hypoxia induced changes in the structure of the pulmonary artery tissue and caused ultrastructural lesions. Proteomics analysis identified 40 DEPs; bioinformatics analysis further revealed that the cholesterol metabolism pathway plays a crucial role in the occurrence of CMS. ELISA and IHC verified that several DEPs (Apo-A1, Apo-C1, Apo-E, IGF-1, Profilin1, and Col1a1) represent critical biological markers in pulmonary artery disease caused by CMS. CONCLUSIONS Irbesartan significantly improved pulmonary artery damage in a rat model of CMS possibly by impacting on the cholesterol metabolism pathway and by reducing damage to vascular endothelial cells. Irbesartan also inhibited the expression levels of IGF-1, Profilin1 and Col1a1 to relieve pulmonary artery pressure and improve lung function by inhibiting vascular remodeling. Several proteins were identified as potential biomarkers of CMS, including Apo-A1, Apo-C1, Apo-E, IGF-1, Profilin1, and Col1a1.
Collapse
Affiliation(s)
- Yiliyaer Nijiati
- Department of Drug Analysis, College of Pharmacy, Xinjiang Medical University, Urumqi 830017, Xinjiang, China; Central Laboratory of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Tao Yang
- Central Laboratory of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Mutalifu Aimaiti
- Central Laboratory of Xinjiang Medical University, Urumqi 830011, Xinjiang, China
| | - Dilinuer Maimaitiyiming
- Heart Center, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang, China
| | - Ainiwaer Aikemu
- Department of Drug Analysis, College of Pharmacy, Xinjiang Medical University, Urumqi 830017, Xinjiang, China; Key Laboratory of Active Components of Xinjiang Natural Medicine and Drug Release Technology, Xinjiang Medical University, Urumqi 830017, China.
| |
Collapse
|
14
|
DeSouza NM, Brewster LM, Bain AR, Garcia VP, Stone R, Stockelman KA, Greiner JJ, Tymko MM, Vizcardo-Galindo G, Figueroa-Mujica RJ, Villafuerte FC, Ainslie PN, DeSouza CA. Global REACH 2018: Influence of excessive erythrocytosis on coagulation and fibrinolytic factors in Andean highlanders. Exp Physiol 2021; 106:1335-1342. [PMID: 33745204 DOI: 10.1113/ep089360] [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: 12/29/2020] [Accepted: 03/17/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Are coagulation and fibrinolytic factors disrupted in Andean highlanders with excessive erythrocytosis? What is the main finding and its importance? Excessive erythrocytosis is not associated with prothombotic disruptions in coagulation or the fibrinolytic system in Andean highlanders. Impairments in coagulation and fibrinolysis may not contribute to the increased vascular risk associated with excessive erythrocytosis. ABSTRACT Increased coagulation and reduced fibrinolysis are central factors underlying thrombotic risk and events. High altitude-induced excessive erythrocytosis (EE) is prevalent in Andean highlanders, contributing to increased cardiovascular risk. Disruption in the coagulation-fibrinolytic axis resulting in uncontrolled fibrin deposition might underlie the increased thrombotic risk associated with high-altitude EE. The experimental aim of this study was to determine whether EE is associated with a prothrombotic blood coagulation and fibrinolytic profile in Andean highlanders. Plasma coagulation factors (von Willebrand factor and factors VII, VIII and X), fibrinolytic factors [tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor-1 (PAI-1)] and D-dimer levels were determined in 26 male residents of Cerro de Pasco, Peru (4340 m a.s.l.): 12 without EE (age, 40 ± 13 years; haemoglobin, 17.4 ± 1.9 g/dl) and 14 with EE (age, 43 ± 15 years; haemoglobin, 24.4 ± 1.6 g/dl). There were no significant differences in von Willebrand factor (40.5 ± 24.8 vs. 45.5 ± 22.4%), factor VII (77.0 ± 14.5 vs. 72.5 ± 8.9%), factor VIII (55.6 ± 19.8 vs. 60.7 ± 26.8%) and factor X (73.9 ± 8.3 vs. 67.3 ± 10.9%) between the Andean highlanders without or with EE. The t-PA antigen (8.5 ± 3.6 vs. 9.6 ± 5.4 ng/ml), t-PA activity (5.5 ± 2.4 vs. 5.8 ± 1.6 IU/ml), PAI antigen (45.0 ± 33.8 vs. 40.5 ± 15.8 ng/ml), PAI-1 activity (0.24 ± 0.09 vs. 0.25 ± 0.11 IU/ml) and the molar concentration ratio of active t-PA to active PAI-1 (1:0.051 ± 0.034 vs. 1:0.046 ± 0.021 mmol/l) were also similar between the groups, as were D-dimer levels (235.0 ± 126.4 vs. 268.4 ± 173.7 ng/ml). Collectively, the results of the present study indicate that EE is not associated with a hypercoagulable, hypofibrinolytic state in Andean highlanders.
Collapse
Affiliation(s)
- Noah M DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA.,Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - L Madden Brewster
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Anthony R Bain
- Department of Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Vinicius P Garcia
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Rachel Stone
- Department of Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Kelly A Stockelman
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Jared J Greiner
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| | - Michael M Tymko
- Neurovascular Health Laboratory, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Gustavo Vizcardo-Galindo
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Romulo J Figueroa-Mujica
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Francisco C Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Christopher A DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado, USA
| |
Collapse
|
15
|
Brewster LM, Bain AR, Garcia VP, Fandl HK, Stone R, DeSouza NM, Greiner JJ, Tymko MM, Vizcardo-Galindo GA, Figueroa-Mujica RJ, Villafuerte FC, Ainslie PN, DeSouza CA. Global REACH 2018: dysfunctional extracellular microvesicles in Andean highlander males with excessive erythrocytosis. Am J Physiol Heart Circ Physiol 2021; 320:H1851-H1861. [PMID: 33710927 DOI: 10.1152/ajpheart.00016.2021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
High altitude-related excessive erythrocytosis (EE) is associated with increased cardiovascular risk. The experimental aim of this study was to determine the effects of microvesicles isolated from Andean highlanders with EE on endothelial cell inflammation, oxidative stress, apoptosis, and nitric oxide (NO) production. Twenty-six male residents of Cerro de Pasco, Peru (4,340 m), were studied: 12 highlanders without EE (age: 40 ± 4 yr; BMI: 26.4 ± 1.7; Hb: 17.4 ± 0.5 g/dL, Spo2: 86.9 ± 1.0%) and 14 highlanders with EE (43 ± 4 yr; 26.2 ± 0.9; 24.4 ± 0.4 g/dL; 79.7 ± 1.6%). Microvesicles were isolated, enumerated, and collected from plasma by flow cytometry. Human umbilical vein endothelial cells were cultured and treated with microvesicles from highlanders without and with EE. Microvesicles from highlanders with EE induced significantly higher release of interleukin (IL)-6 (89.8 ± 2.7 vs. 77.1 ± 1.9 pg/mL) and IL-8 (62.0 ± 2.7 vs. 53.3 ± 2.2 pg/mL) compared with microvesicles from healthy highlanders. Although intracellular expression of total NF-κB p65 (65.3 ± 6.0 vs. 74.9 ± 7.8.9 AU) was not significantly affected in cells treated with microvesicles from highlanders without versus with EE, microvesicles from highlanders with EE resulted in an ∼25% higher (P < 0.05) expression of p-NF-κB p65 (173.6 ± 14.3 vs. 132.8 ± 12.2 AU). Cell reactive oxygen species production was significantly higher (76.4.7 ± 5.4 vs. 56.7 ± 1.7% of control) and endothelial nitric oxide synthase (p-eNOS) activation (231.3 ± 15.5 vs. 286.6 ± 23.0 AU) and NO production (8.3 ± 0.6 vs. 10.7 ± 0.7 μM/L) were significantly lower in cells treated with microvesicles from highlanders with versus without EE. Cell apoptotic susceptibility was not significantly affected by EE-related microvesicles. Circulating microvesicles from Andean highlanders with EE increased endothelial cell inflammation and oxidative stress and reduced NO production.NEW & NOTEWORTHY In this study, we determined the effects of microvesicles isolated from Andean highlanders with excessive erythrocytosis (EE) on endothelial cell inflammation, oxidative stress, apoptosis, and NO production. Microvesicles from highlanders with EE induced a dysfunctional response from endothelial cells characterized by increased cytokine release and expression of active nuclear factor-κB and reduced nitric oxide production. Andean highlanders with EE exhibit dysfunctional circulating extracellular microvesicles that induce a proinflammatory, proatherogenic endothelial phenotype.
Collapse
Affiliation(s)
- L Madden Brewster
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Anthony R Bain
- Department of Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Vinicius P Garcia
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Hannah K Fandl
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | - Rachel Stone
- Department of Kinesiology, University of Windsor, Windsor, Ontario, Canada
| | - Noah M DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado.,Faculty of Health and Social Development, Centre for Heart, Lung and Vascular Health, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Jared J Greiner
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| | | | | | | | | | - Philip N Ainslie
- Faculty of Health and Social Development, Centre for Heart, Lung and Vascular Health, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Christopher A DeSouza
- Integrative Vascular Biology Laboratory, Department of Integrative Physiology, University of Colorado, Boulder, Colorado
| |
Collapse
|
16
|
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.
Collapse
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.
| |
Collapse
|
17
|
Sánchez K, Ballaz SJ. Might a high hemoglobin mass be involved in non-cardiogenic pulmonary edema? The case of the chronic maladaptation to high-altitude in the Andes. Med Hypotheses 2020; 146:110418. [PMID: 33268002 DOI: 10.1016/j.mehy.2020.110418] [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: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 10/22/2022]
Abstract
Exposure to hypoxic environments when ascending at high altitudes may cause life-threatening pulmonary edema (HAPE) due to a rapid accumulation of extracellular fluid flooding in the pulmonary alveoli. In Andeans, high-altitude adaptation occurs at the expense of being more prone to chronic mountain sickness: relative hypoventilation, excess pulmonary hypertension, and secondary polycythemia. Because HAPE prevalence is high in the Andes, we posit the hypothesis that a high hemoglobine mass may increase HAPE risk. In support of it, high intrapulmonary hypertension along with hyperviscosity produced by polycytemia may enhance sear forces and intravascular hemolysis, thus leading to increased acellular hemoglobin and the subsequent damage of the alveolar and endothelial barrier. It is proposed to investigate the relationship between the vaso-endothelial homeostasis and erythropoiesis in the maladaptation to high altitude and HAPE. This research is especially important when reentry HAPE, since rheologic properties of blood changes with rapid ascent to high altitudes.
Collapse
Affiliation(s)
- Karen Sánchez
- School of Biological Sciences & Engineering. Yachay Tech University, San Miguel de Urcuquí, Ecuador
| | - Santiago J Ballaz
- School of Biological Sciences & Engineering. Yachay Tech University, San Miguel de Urcuquí, Ecuador.
| |
Collapse
|
18
|
Bilo G, Acone L, Anza-Ramírez C, Macarlupú JL, Soranna D, Zambon A, Vizcardo-Galindo G, Pengo MF, Villafuerte FC, Parati G. Office and Ambulatory Arterial Hypertension in Highlanders: HIGHCARE-ANDES Highlanders Study. Hypertension 2020; 76:1962-1970. [PMID: 33175629 DOI: 10.1161/hypertensionaha.120.16010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Millions of people worldwide live at high altitude, being chronically exposed to hypobaric hypoxia. Hypertension is a major cardiovascular risk factor but data on its prevalence and determinants in highlanders are limited, and systematic studies with ambulatory blood pressure monitoring are not available. Aim of this study was to assess the prevalence of clinic and ambulatory hypertension and the associated factors in a sample of Andean highlanders. Hypertension prevalence and phenotypes were assessed with office and ambulatory blood pressure measurement in a sample of adults living in Cerro de Pasco, Peru (altitude 4340 m). Basic clinical data, blood oxygen saturation, hematocrit, and Qinghai Chronic Mountain Sickness score were obtained. Participants were classified according to the presence of excessive erythrocytosis and chronic mountain sickness diagnosis. Data of 289 participants (143 women, 146 men, mean age 38.3 years) were analyzed. Office hypertension was present in 20 (7%) participants, while ambulatory hypertension was found in 58 (20%) participants. Masked hypertension was common (15%), and white coat hypertension was rare (2%). Among participants with ambulatory hypertension, the most prevalent phenotypes included isolated nocturnal hypertension, isolated diastolic hypertension, and systodiastolic hypertension. Ambulatory hypertension was associated with male gender, age, overweight/obesity, 24-hour heart rate, and excessive erythrocytosis. Prevalence of hypertension among Andean highlanders may be significantly underestimated when based on conventional blood pressure measurements, due to the high prevalence of masked hypertension. In highlanders, ambulatory hypertension may be independently associated with excessive erythrocytosis.
Collapse
Affiliation(s)
- Grzegorz Bilo
- From the Department of Cardiovascular, Neural and Metabolic Sciences (G.B., M.F.P., G.P.), University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Milan, Italy Department of Medicine and Surgery (G.B., L.A., G.P.), University of Milano-Bicocca, Milan, Italy
| | - Lorenzo Acone
- Istituto Auxologico Italiano, IRCCS, Milan, Italy Department of Medicine and Surgery (G.B., L.A., G.P.), University of Milano-Bicocca, Milan, Italy
| | - Cecilia Anza-Ramírez
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - José Luis Macarlupú
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - Davide Soranna
- Biostatistics Unit (D.S., A.Z.), University of Milano-Bicocca, Milan, Italy
| | - Antonella Zambon
- Biostatistics Unit (D.S., A.Z.), University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods (A.Z.), University of Milano-Bicocca, Milan, Italy
| | - Gustavo Vizcardo-Galindo
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - Martino F Pengo
- From the Department of Cardiovascular, Neural and Metabolic Sciences (G.B., M.F.P., G.P.), University of Milano-Bicocca, Milan, Italy
| | - Francisco C Villafuerte
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno-LID. Universidad Peruana Cayetano Heredia, Lima, Perú (C.A.-R., J.L.M., G.V.-G., F.C.V.)
| | - Gianfranco Parati
- From the Department of Cardiovascular, Neural and Metabolic Sciences (G.B., M.F.P., G.P.), University of Milano-Bicocca, Milan, Italy.,Istituto Auxologico Italiano, IRCCS, Milan, Italy Department of Medicine and Surgery (G.B., L.A., G.P.), University of Milano-Bicocca, Milan, Italy
| | | |
Collapse
|
19
|
Tymko MM, Hoiland RL, Vermeulen TD, Howe CA, Tymko C, Stone RM, Steinback CD, Steele AR, Villafuerte F, Vizcardo-Galindo G, Mujica RJF, Ainslie PN. Global REACH 2018: The carotid artery diameter response to the cold pressor test is governed by arterial blood pressure during normoxic but not hypoxic conditions in healthy lowlanders and Andean highlanders. Exp Physiol 2020; 105:1742-1757. [PMID: 32829509 DOI: 10.1113/ep088898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 08/18/2020] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? What is the impact of oxygen on the circulatory responses to an isocapnic cold pressor test (CPT) in lowlanders and Andean highlanders? What is the main finding and its importance? Overall, the circulatory responses to an isocapnic CPT were largely unaltered with acute normobaric hypoxia and chronic hypobaric hypoxia exposure in lowlanders. However, the relationship between mean arterial pressure and common carotid artery diameter was dampened in hypoxic conditions. Furthermore, there were no differences in the circulatory responses to the CPT between lowlanders and Andean highlanders with lifelong exposure to high altitude. ABSTRACT The impact of oxygen on the circulatory responses to a cold pressor test (CPT) in lowlanders and Andean highlanders remains unknown. Our hypotheses were as follows: (i) in lowlanders, acute normobaric and hypobaric hypoxia would attenuate the common carotid artery (CCA) diameter response to the CPT compared with normobaric normoxia; (ii) Andean highlanders would exhibit a greater CCA diameter response compared with lowlanders; and (iii) a positive relationship between CCA diameter and blood pressure in response to the CPT would be present in both lowlanders and highlanders. Healthy lowlanders (n = 13) and Andean highlanders (n = 8) were recruited and conducted an isocapnic CPT, which consisted of a 3 min foot immersion into water at 0-1°C. Blood pressure (finger photoplethysmography) and CCA diameter and blood flow (Duplex ultrasound) were recorded continuously. The CPT was conducted in lowlanders at sea level in isocapnic normoxic and hypoxic conditions and after 10 days of acclimatization to 4300 m (Cerro de Pasco, Peru) in hypoxic and hyperoxic conditions. Andean highlanders were tested at rest at high altitude. The main findings were as follows: (i) in lowlanders, normobaric but not hypobaric hypoxia elevated CCA reactivity to the CPT; (ii) no differences in response to the CPT were observed between lowlanders and highlanders; and (iii) although hypobaric hypoxaemia reduced the relationship between CCA diameter and blood pressure compared with normobaric normoxia (P = 0.132), hypobaric hyperoxia improved this relationship (P = 0.012), and no relationship was observed in Andean highlanders (P = 0.261). These data demonstrate that the circulatory responses to a CPT were modified by oxygen in lowlanders, but were unaltered with lifelong hypoxic exposure.
Collapse
Affiliation(s)
- Michael M Tymko
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada.,Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| | - Ryan L Hoiland
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada.,Department of Anesthesiology, Pharmacology, and Therapeutics, Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Tyler D Vermeulen
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada.,Neurovascular Research Laboratory, School of Kinesiology, Western University, London, Ontario, Canada
| | - Connor A Howe
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| | - Courtney Tymko
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| | - Rachel M Stone
- Faculty of Human Kinetics, University of Windsor, Windsor, Ontario, Canada
| | - Craig D Steinback
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Andrew R Steele
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Francisco Villafuerte
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Gustavo Vizcardo-Galindo
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Romulo Joseph Figueroa Mujica
- Laboratorio de Fisiología Comparada/Fisiología del Transporte de Oxígeno, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| |
Collapse
|
20
|
Liu M, Galli G, Wang Y, Fan Q, Wang Z, Wang X, Xiao W. Novel Therapeutic Targets for Hypoxia-Related Cardiovascular Diseases: The Role of HIF-1. Front Physiol 2020; 11:774. [PMID: 32760290 PMCID: PMC7375027 DOI: 10.3389/fphys.2020.00774] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/12/2020] [Indexed: 12/17/2022] Open
Abstract
Insufficient oxygen availability (hypoxia) is a precursor to numerous cardiovascular diseases, including atherosclerosis, pulmonary hypertension, and heart failure. The main site of hypoxic injury in the human body is the mitochondria, where oxygen acts as the final electron acceptor in the process of oxidative phosphorylation. Hypoxia-inducible factor (HIF) is activated in hypoxic conditions and acts as an important modulator of diverse target genes in the human body. The downstream genes of HIF include vital modulators of cardiovascular-related signaling pathways. Therefore, it is hypothesized that HIF represents a potential therapeutic target for the treatment and prevention of cardiovascular diseases. In this short review, we introduce the pathophysiology of hypoxic injury in cardiovascular disease, and we conclude from convincing evidence that HIF can modulate relevant cardioprotective signaling pathways.
Collapse
Affiliation(s)
- Minxuan Liu
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, China
| | - Gina Galli
- Faculty of Life Sciences, The University of Manchester, Manchester, United Kingdom
| | - Yilin Wang
- Pharmaceutical Sciences, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Qiru Fan
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, China.,Life Science and Technology, China Pharmaceutical University, Nanjing, China
| | - Zhenzhong Wang
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, China
| | - Xin Wang
- Faculty of Life Sciences, The University of Manchester, Manchester, United Kingdom
| | - Wei Xiao
- State Key Laboratory of New-tech for Chinese Medicine Pharmaceutical Process, Lianyungang, China
| |
Collapse
|
21
|
Gupta A, Gupta R, Kumar V, Samarany S. Blue Toes at High Altitude: Peripheral Cyanosis. Am J Med 2020; 133:573-575. [PMID: 31668899 DOI: 10.1016/j.amjmed.2019.08.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Amol Gupta
- Heart, Vascular, and Leg Center, Bakersfield, Calif
| | - Ravi Gupta
- Heart, Vascular, and Leg Center, Bakersfield, Calif
| | - Vinod Kumar
- Heart, Vascular, and Leg Center, Bakersfield, Calif.
| | | |
Collapse
|
22
|
Tymko MM, Lawley JS, Ainslie PN, Hansen AB, Hofstaetter F, Rainer S, Amin S, Moralez G, Gasho C, Vizcardo-Galindo G, Bermudez D, Villafuerte FC, Hearon CM. Global Reach 2018 Heightened α-Adrenergic Signaling Impairs Endothelial Function During Chronic Exposure to Hypobaric Hypoxia. Circ Res 2020; 127:e1-e13. [PMID: 32268833 DOI: 10.1161/circresaha.119.316053] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
RATIONALE Chronic exposure to hypoxia is associated with elevated sympathetic nervous activity and reduced vascular function in lowlanders, and Andean highlanders suffering from excessive erythrocytosis (EE); however, the mechanistic link between chronically elevated sympathetic nervous activity and hypoxia-induced vascular dysfunction has not been determined. OBJECTIVE To determine the impact of heightened sympathetic nervous activity on resistance artery endothelial-dependent dilation (EDD), and endothelial-independent dilation, in lowlanders and Andean highlanders with and without EE. METHODS AND RESULTS We tested healthy lowlanders (n=9) at sea level (344 m) and following 14 to 21 days at high altitude (4300 m), and permanent Andean highlanders with (n=6) and without (n=9) EE at high altitude. Vascular function was assessed using intraarterial infusions (3 progressive doses) of acetylcholine (ACh; EDD) and sodium nitroprusside (endothelial-independent dilation) before and after local α+β adrenergic receptor blockade (phentolamine and propranolol). Intraarterial blood pressure, heart rate, and simultaneous brachial artery diameter and blood velocity were recorded at rest and during drug infusion. Changes in forearm vascular conductance were calculated. The main findings were (1) chronic hypoxia reduced EDD in lowlanders (changes in forearm vascular conductance from sea level: ACh1: -52.7±19.6%, ACh2: -25.4±38.7%, ACh3: -35.1±34.7%, all P≤0.02); and in Andeans with EE compared with non-EE (changes in forearm vascular conductance at ACh3: -36.4%, P=0.007). Adrenergic blockade fully restored EDD in lowlanders at high altitude, and normalized EDD between EE and non-EE Andeans. (2) Chronic hypoxia had no effect on endothelial-independent dilation in lowlanders, and no differences were detected between EE and non-EE Andeans; however, EID was increased in the non-EE Andeans after adrenergic blockade (P=0.012), but this effect was not observed in the EE Andeans. CONCLUSIONS These data indicate that chronic hypoxia reduces EDD via heightened α-adrenergic signaling in lowlanders and in Andeans with EE. These vascular mechanisms have important implications for understanding the physiological consequences of acute and chronic high altitude adaptation.
Collapse
Affiliation(s)
- Michael M Tymko
- From the Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada (M.M.T., P.N.A.).,Neurovascular Health Lab, Faculty of Kinesiology, Sport and Recreation, University of Alberta, Edmonton, Canada (M.M.T.)
| | - Justin S Lawley
- University of Innsbruck, Austria (J.S.L., A.B.H., F.H., S.R., S.A.)
| | - Philip N Ainslie
- From the Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Science, University of British Columbia, Kelowna, Canada (M.M.T., P.N.A.)
| | | | | | - Simon Rainer
- University of Innsbruck, Austria (J.S.L., A.B.H., F.H., S.R., S.A.)
| | - Sachin Amin
- University of Innsbruck, Austria (J.S.L., A.B.H., F.H., S.R., S.A.)
| | - Gilbert Moralez
- Department of Applied Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX (G.M.)
| | | | | | | | | | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital of Dallas (C.M.H.).,Department of Internal Medicine, University of Texas Southwestern Medical Center (C.M.H.)
| |
Collapse
|
23
|
Garrido E, Botella de Maglia J, Castillo O. Acute, subacute and chronic mountain sickness. Rev Clin Esp 2020; 221:S0014-2565(20)30064-3. [PMID: 32197780 DOI: 10.1016/j.rce.2019.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022]
Abstract
More than 100 million people ascend to high mountainous areas worldwide every year. At nonextreme altitudes (<5500 m), 10-85% of these individuals are affected by acute mountain sickness, the most common disease induced by mild-moderate hypobaric hypoxia. Approximately 140 million individuals live permanently at heights of 2500-5500 m, and up to 10% of them are affected by the subacute form of mountain sickness (high-altitude pulmonary hypertension) or the chronic form (Monge's disease), the latter of which is especially common in Andean ethnicities. This review presents the most relevant general concepts of these 3 clinical variants, which can be incapacitating and can result in complications and become life-threatening. Proper prevention, diagnosis, treatment and management of these conditions in a hostile environment such as high mountains are therefore essential.
Collapse
Affiliation(s)
- E Garrido
- Servicio de Hipobaria y Fisiología Biomédica, Universidad de Barcelona, L'Hospitalet de Llobregat, Barcelona, España; Instituto de Estudios de Medicina de Montaña (IEMM), Barcelona, España.
| | - J Botella de Maglia
- Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, España; Instituto de Estudios de Medicina de Montaña (IEMM), Barcelona, España
| | - O Castillo
- Instituto Nacional de Biología Andina, Universidad Nacional Mayor de San Marcos, Lima, Perú
| |
Collapse
|
24
|
Tymko MM, Tremblay JC, Bailey DM, Green DJ, Ainslie PN. The impact of hypoxaemia on vascular function in lowlanders and high altitude indigenous populations. J Physiol 2019; 597:5759-5776. [PMID: 31677355 DOI: 10.1113/jp277191] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/07/2019] [Indexed: 12/18/2022] Open
Abstract
Exposure to hypoxia elicits widespread physiological responses that are critical for successful acclimatization; however, these responses may induce apparent maladaptive consequences. For example, recent studies conducted in both the laboratory and the field (e.g. at high altitude) have demonstrated that endothelial function is reduced in hypoxia. Herein, we review the several proposed mechanism(s) pertaining to the observed reduction in endothelial function in hypoxia including: (i) changes in blood flow patterns (i.e. shear stress), (ii) increased inflammation and production of reactive oxygen species (i.e. oxidative stress), (iii) heightened sympathetic nerve activity, and (iv) increased red blood cell concentration and mass leading to elevated nitric oxide scavenging. Although some of these mechanism(s) have been examined in lowlanders, less in known about endothelial function in indigenous populations that have chronically adapted to environmental hypoxia for millennia (e.g. the Peruvian, Tibetan and Ethiopian highlanders). There is some evidence indicating that healthy Tibetan and Peruvian (i.e. Andean) highlanders have preserved endothelial function at high altitude, but less is known about the Ethiopian highlanders. However, Andean highlanders suffering from chronic mountain sickness, which is characterized by an excessive production of red blood cells, have markedly reduced endothelial function. This review will provide a framework and mechanistic model for vascular endothelial adaptation to hypoxia in lowlanders and highlanders. Elucidating the pathways responsible for vascular adaption/maladaptation to hypoxia has potential clinical implications for disease featuring low oxygen delivery (e.g. heart failure, pulmonary disease). In addition, a greater understanding of vascular function at high altitude will clinically benefit the global estimated 85 million high altitude residents.
Collapse
Affiliation(s)
- Michael M Tymko
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada.,Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Joshua C Tremblay
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, UK
| | - Daniel J Green
- Cardiovascular Research Group, School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Australia.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, School of Health and Exercise Sciences, University of British Columbia - Okanagan, Kelowna, British Columbia, Canada
| |
Collapse
|
25
|
Tremblay JC, Hoiland RL, Howe CA, Coombs GB, Vizcardo-Galindo GA, Figueroa-Mujíca RJ, Bermudez D, Gibbons TD, Stacey BS, Bailey DM, Tymko MM, MacLeod DB, Gasho C, Villafuerte FC, Pyke KE, Ainslie PN. Global REACH 2018: High Blood Viscosity and Hemoglobin Concentration Contribute to Reduced Flow-Mediated Dilation in High-Altitude Excessive Erythrocytosis. Hypertension 2019; 73:1327-1335. [PMID: 31006327 DOI: 10.1161/hypertensionaha.119.12780] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Excessive erythrocytosis (EE; hemoglobin concentration [Hb] ≥21 g/dL in adult males) is associated with increased cardiovascular risk in highlander Andeans. We sought to quantify shear stress and assess endothelial function via flow-mediated dilation (FMD) in male Andeans with and without EE. We hypothesized that FMD would be impaired in Andeans with EE after accounting for shear stress and that FMD would improve after isovolemic hemodilution. Brachial artery shear stress and FMD were assessed in 23 male Andeans without EE (age: 40±15 years [mean±SD]; Hb<21 g/dL) and 19 male Andeans with EE (age: 43±14 years; Hb≥21 g/dL) in Cerro de Pasco, Peru (4330 m). Shear stress was quantified from Duplex ultrasound measures of shear rate and blood viscosity. In a subset of participants (n=8), FMD was performed before and after isovolemic hemodilution with blood volume replaced by an equal volume of human serum albumin. Blood viscosity and Hb were 48% and 23% higher (both P<0.001) and FMD was 28% lower after adjusting for the shear stress stimulus ( P=0.013) in Andeans with EE compared to those without. FMD was inversely correlated with blood viscosity ( r2=0.303; P<0.001) and Hb ( r2=0.230; P=0.001). Isovolemic hemodilution decreased blood viscosity by 30±10% and Hb by 14±5% (both P<0.001) and improved shear stress stimulus-adjusted FMD from 2.7±1.9% to 4.3±1.9% ( P=0.022). Hyperviscosity, high Hb, or both, actively contribute to acutely reversible impairments in FMD in EE, suggesting that this plays a pathogenic role in the increased cardiovascular risk.
Collapse
Affiliation(s)
- Joshua C Tremblay
- From the Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada (J.C.T., K.E.P.)
| | - Ryan L Hoiland
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - Connor A Howe
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - Geoff B Coombs
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - Gustavo A Vizcardo-Galindo
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Rómulo J Figueroa-Mujíca
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Daniela Bermudez
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Travis D Gibbons
- School of Physical Education, Sport and Exercise Sciences, Division of Sciences, University of Otago, Dunedin, New Zealand (T.D.G.)
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, United Kingdom (B.S.S., D.M.B.)
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, United Kingdom (B.S.S., D.M.B.)
| | - Michael M Tymko
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| | - David B MacLeod
- Human Pharmacology and Physiology Laboratory, Department of Anesthesiology, Duke University Medical Center, Durham, NC (D.B.M.)
| | - Chris Gasho
- Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Loma Linda University School of Medicine, CA (C.G.)
| | - Francisco C Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú (G.A.V.-G., R.J.F.-M., D.B., F.C.V.)
| | - Kyra E Pyke
- From the Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada (J.C.T., K.E.P.)
| | - Philip N Ainslie
- Centre for Heart, Lung & Vascular Health, Faculty of Health and Social Development, University of British Columbia-Okanagan, Kelowna, Canada (R.L.H., C.A.H., G.B.C., M.M.T., P.N.A.)
| |
Collapse
|
26
|
Wachsmuth N, Soria R, Jimenez J, Schmidt W. Modification of the CO‐rebreathing method to determine haemoglobin mass and blood volume in patients suffering from chronic mountain sickness. Exp Physiol 2019; 104:1819-1828. [DOI: 10.1113/ep087870] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Nadine Wachsmuth
- Department of Sports Medicine & Sports PhysiologyUniversity of Bayreuth Bayreuth Germany
| | - Rudy Soria
- Instituto Boliviano de Biologia de AlturaUniversidad Mayor de San Andres La Paz Bolivia
| | - Jesus Jimenez
- Instituto Boliviano de Biologia de AlturaUniversidad Mayor de San Andres La Paz Bolivia
| | - Walter Schmidt
- Department of Sports Medicine & Sports PhysiologyUniversity of Bayreuth Bayreuth Germany
| |
Collapse
|
27
|
Meister TA, Rimoldi SF, Soria R, von Arx R, Messerli FH, Sartori C, Scherrer U, Rexhaj E. Association of Assisted Reproductive Technologies With Arterial Hypertension During Adolescence. J Am Coll Cardiol 2019; 72:1267-1274. [PMID: 30190005 DOI: 10.1016/j.jacc.2018.06.060] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/15/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Assisted reproductive technologies (ART) have been shown to induce premature vascular aging in apparently healthy children. In mice, ART-induced premature vascular aging evolves into arterial hypertension. Given the young age of the human ART group, long-term sequelae of ART-induced alterations of the cardiovascular phenotype are unknown. OBJECTIVES This study hypothesized that vascular alterations persist in adolescents and young adults conceived by ART and that arterial hypertension possibly represents the first detectable clinically relevant endpoint in this group. METHODS Five years after the initial assessment, the study investigators reassessed vascular function and performed 24-h ambulatory blood pressure (BP) monitoring (ABPM) in 54 young, apparently healthy participants conceived through ART and 43 age- and sex-matched controls. RESULTS Premature vascular aging persisted in ART-conceived subjects, as evidenced by a roughly 25% impairment of flow-mediated dilation of the brachial artery (p < 0.001) and increased pulse-wave velocity and carotid intima-media thickness. Most importantly, ABPM values (systolic BP, 119.8 ± 9.1 mm Hg vs. 115.7 ± 7.0 mm Hg, p = 0.03; diastolic BP, 71.4 ± 6.1 mm Hg vs. 69.1 ± 4.2 mm Hg, p = 0.02 ART vs. control) and BP variability were markedly higher in ART-conceived subjects than in control subjects. Eight of the 52 ART participants, but only 1 of the 43 control participants (p = 0.041 ART vs. controls) fulfilled ABPM criteria of arterial hypertension (>130/80 mm Hg and/or >95th percentile). CONCLUSIONS ART-induced premature vascular aging persists in apparently healthy adolescents and young adults without any other detectable classical cardiovascular risk factors and progresses to arterial hypertension. (Vascular Dysfunction in Offspring of Assisted Reproduction Technologies; NCT00837642.).
Collapse
Affiliation(s)
- Théo A Meister
- Department of Cardiology, University Hospital and Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Stefano F Rimoldi
- Department of Cardiology, University Hospital and Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Rodrigo Soria
- Department of Cardiology, University Hospital and Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Robert von Arx
- Department of Cardiology, University Hospital and Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Franz H Messerli
- Department of Cardiology, University Hospital and Department for Biomedical Research, University of Bern, Bern, Switzerland
| | - Claudio Sartori
- Department of Internal Medicine, University Hospital, Lausanne, Switzerland
| | - Urs Scherrer
- Department of Cardiology, University Hospital and Department for Biomedical Research, University of Bern, Bern, Switzerland; Faculty of Sciences, Department of Biology, University of Tarapacá, Arica, Chile
| | - Emrush Rexhaj
- Department of Cardiology, University Hospital and Department for Biomedical Research, University of Bern, Bern, Switzerland.
| |
Collapse
|
28
|
Tremblay JC, Coombs GB, Howe CA, Vizcardo-Galindo GA, Figueroa-Mujíca RJ, Bermudez D, Tymko MM, Villafuerte FC, Ainslie PN, Pyke KE. Global Reach 2018: reduced flow-mediated dilation stimulated by sustained increases in shear stress in high-altitude excessive erythrocytosis. Am J Physiol Heart Circ Physiol 2019; 317:H991-H1001. [PMID: 31441692 DOI: 10.1152/ajpheart.00316.2019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Excessive erythrocytosis [EE; hemoglobin concentration (Hb) ≥ 21 g/dL in adult men] is a maladaptive high-altitude pathology associated with increased cardiovascular risk and reduced reactive hyperemia flow-mediated dilation (FMD); however, whether a similar impairment occurs in response to more commonly encountered sustained increases in shear stress [sustained stimulus (SS)-FMD] over a range of overlapping stimuli is unknown. We characterized SS-FMD in response to handgrip exercise in Andeans with and without EE in Cerro de Pasco, Peru (4,330 m). Andean highlanders with EE (n = 17, Hb = 23.2 ± 1.2 g/dL) and without EE (n = 23, Hb = 18.7 ± 1.9 g/dL) performed 3 min of rhythmic handgrip exercise at 20, 35, and 50% of maximum voluntary contraction (MVC). Duplex ultrasound was used to continuously record blood velocity and diameter in the brachial artery, and blood viscosity was measured to accurately calculate shear stress. Although baseline shear stress did not differ, Andeans with EE had 22% lower shear stress than Andeans without at 50% MVC (P = 0.004). At 35 and 50% MVC, SS-FMD was 2.1 ± 2.0 and 2.8 ± 2.7% in Andeans with EE compared with 4.1 ± 3.4 and 7.5 ± 4.5% in those without (P = 0.048 and P < 0.001). The stimulus-response slope (∆shear stress vs. ∆diameter) was lower in Andeans with EE compared with Andeans without (P = 0.028). This slope was inversely related to Hb in Andeans with EE (r2 = 0.396, P = 0.007). A reduced SS-FMD in response to small muscle mass exercise in Andeans with EE indicates a generalized reduction in endothelial sensitivity to shear stress, which may contribute to increased cardiovascular risk in this population.NEW & NOTEWORTHY High-altitude excessive erythrocytosis (EE; hemoglobin concentration ≥ 21 g/dL) is a maladaptation to chronic hypoxia exposure and is associated with increased cardiovascular risk. We examined flow-mediated dilation (FMD) in response to sustained elevations in shear stress achieved using progressive handgrip exercise [sustained stimulus (SS)-FMD] in Andean highlanders with and without EE at 4,330 m. Andeans with EE demonstrated lower SS-FMD compared with those without. Heightened hemoglobin concentration was related to lower SS-FMD in Andeans with EE.
Collapse
Affiliation(s)
- Joshua C Tremblay
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Geoff B Coombs
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Connor A Howe
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Gustavo A Vizcardo-Galindo
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rómulo J Figueroa-Mujíca
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Daniela Bermudez
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Michael M Tymko
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Francisco C Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Philip N Ainslie
- Centre for Heart, Lung and Vascular Health, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Kyra E Pyke
- Cardiovascular Stress Response Laboratory, School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
29
|
Soria R, Egger M, Scherrer U, Bender N, Rimoldi SF. Pulmonary arterial pressure at rest and during exercise in chronic mountain sickness: a meta-analysis. Eur Respir J 2019; 53:13993003.02040-2018. [PMID: 31023845 DOI: 10.1183/13993003.02040-2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 03/21/2019] [Indexed: 01/22/2023]
Abstract
Up to 10% of the more than 140 million high-altitude dwellers worldwide suffer from chronic mountain sickness (CMS). Patients suffering from this debilitating problem often display increased pulmonary arterial pressure (PAP), which may contribute to exercise intolerance and right heart failure. However, there is little information on the usual PAP in these patients.We systematically reviewed and meta-analysed all data published in English or Spanish until June 2018 on echocardiographic estimations of PAP at rest and during mild exercise in CMS patients.Nine studies comprising 287 participants fulfilled the inclusion criteria. At rest, the point estimate from meta-analysis of the mean systolic PAP was 27.9 mmHg (95% CI 26.3-29.6 mmHg). These values are 11% (+2.7 mmHg) higher than those previously meta-analysed in apparently healthy high-altitude dwellers. During mild exercise (50 W) the difference in mean systolic PAP between patients and high-altitude dwellers was markedly more accentuated (48.3 versus 36.3 mmHg) than at rest.These findings indicate that in patients with CMS PAP is moderately increased at rest, but markedly increased during mild exercise, which will be common with activities of daily living.
Collapse
Affiliation(s)
- Rodrigo Soria
- Dept of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Urs Scherrer
- Dept of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland.,Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile
| | - Nicole Bender
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.,These two authors contributed equally to this work
| | - Stefano F Rimoldi
- Dept of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland .,These two authors contributed equally to this work
| |
Collapse
|
30
|
Sleep Disordered Breathing at High Altitude in Adults and Its Interaction with Cardiovascular Homeostasis. CURRENT SLEEP MEDICINE REPORTS 2019. [DOI: 10.1007/s40675-019-00138-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
31
|
Human Genetic Adaptation to High Altitude: Evidence from the Andes. Genes (Basel) 2019; 10:genes10020150. [PMID: 30781443 PMCID: PMC6410003 DOI: 10.3390/genes10020150] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/29/2019] [Accepted: 02/11/2019] [Indexed: 12/31/2022] Open
Abstract
Whether Andean populations are genetically adapted to high altitudes has long been of interest. Initial studies focused on physiological changes in the O₂ transport system that occur with acclimatization in newcomers and their comparison with those of long-resident Andeans. These as well as more recent studies indicate that Andeans have somewhat larger lung volumes, narrower alveolar to arterial O₂ gradients, slightly less hypoxic pulmonary vasoconstrictor response, greater uterine artery blood flow during pregnancy, and increased cardiac O2 utilization, which overall suggests greater efficiency of O₂ transfer and utilization. More recent single nucleotide polymorphism and whole-genome sequencing studies indicate that multiple gene regions have undergone recent positive selection in Andeans. These include genes involved in the regulation of vascular control, metabolic hemostasis, and erythropoiesis. However, fundamental questions remain regarding the functional links between these adaptive genomic signals and the unique physiological attributes of highland Andeans. Well-designed physiological and genome association studies are needed to address such questions. It will be especially important to incorporate the role of epigenetic processes (i.e.; non-sequence-based features of the genome) that are vital for transcriptional responses to hypoxia and are potentially heritable across generations. In short, further exploration of the interaction among genetic, epigenetic, and environmental factors in shaping patterns of adaptation to high altitude promises to improve the understanding of the mechanisms underlying human adaptive potential and clarify its implications for human health.
Collapse
|
32
|
Siques P, Brito J, Pena E. Reactive Oxygen Species and Pulmonary Vasculature During Hypobaric Hypoxia. Front Physiol 2018; 9:865. [PMID: 30050455 PMCID: PMC6052911 DOI: 10.3389/fphys.2018.00865] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/18/2018] [Indexed: 12/12/2022] Open
Abstract
An increasing number of people are living or working at high altitudes (hypobaric hypoxia) and therefore suffering several physiological, biochemical, and molecular changes. Pulmonary vasculature is one of the main and first responses to hypoxia. These responses imply hypoxic pulmonary vasoconstriction (HPV), remodeling, and eventually pulmonary hypertension (PH). These events occur according to the type and extension of the exposure. There is also increasing evidence that these changes in the pulmonary vascular bed could be mainly attributed to a homeostatic imbalance as a result of increased levels of reactive oxygen species (ROS). The increase in ROS production during hypobaric hypoxia has been attributed to an enhanced activity and expression of nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase), though there is some dispute about which subunit is involved. This enzymatic complex may be directly induced by hypoxia-inducible factor-1α (HIF-1α). ROS has been found to be related to several pathways, cells, enzymes, and molecules in hypoxic pulmonary vasculature responses, from HPV to inflammation, and structural changes, such as remodeling and, ultimately, PH. Therefore, we performed a comprehensive review of the current evidence on the role of ROS in the development of pulmonary vasculature changes under hypoxic conditions, with a focus on hypobaric hypoxia. This review provides information supporting the role of oxidative stress (mainly ROS) in the pulmonary vasculature’s responses under hypobaric hypoxia and depicting possible future therapeutics or research targets. NADPH oxidase-produced oxidative stress is highlighted as a major source of ROS. Moreover, new molecules, such as asymmetric dimethylarginine, and critical inflammatory cells as fibroblasts, could be also involved. Several controversies remain regarding the role of ROS and the mechanisms involved in hypoxic responses that need to be elucidated.
Collapse
Affiliation(s)
- Patricia Siques
- Institute of Health Studies, Arturo Prat University, Iquique, Chile
| | - Julio Brito
- Institute of Health Studies, Arturo Prat University, Iquique, Chile
| | - Eduardo Pena
- Institute of Health Studies, Arturo Prat University, Iquique, Chile
| |
Collapse
|
33
|
Corante N, Anza-Ramírez C, Figueroa-Mujíca R, Macarlupú JL, Vizcardo-Galindo G, Bilo G, Parati G, Gamboa JL, León-Velarde F, Villafuerte FC. Excessive Erythrocytosis and Cardiovascular Risk in Andean Highlanders. High Alt Med Biol 2018; 19:221-231. [PMID: 29782186 PMCID: PMC6157350 DOI: 10.1089/ham.2017.0123] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Corante, Noemí, Cecilia Anza-Ramírez, Rómulo Figueroa-Mujíca, José Luis Macarlupú, Gustavo Vizcardo-Galindo, Grzegorz Bilo, Gianfranco Parati, Jorge L. Gamboa, Fabiola León-Velarde, and Francisco C. Villafuerte. Excessive erythrocytosis and cardiovascular risk in Andean highlanders. High Alt Med Biol. 19:221–231, 2018.—Cardiovascular diseases are the main cause of death worldwide. Life under high-altitude (HA) hypoxic conditions is believed to provide highlanders with a natural protection against cardiovascular and metabolic diseases compared with sea-level inhabitants. However, some HA dwellers become intolerant to chronic hypoxia and develop a progressive incapacitating syndrome known as chronic mountain sickness (CMS), characterized by excessive erythrocytosis (EE; Hb ≥21 g/dL in men, Hb ≥19 g/dL in women). Evidence from HA studies suggests that, in addition to CMS typical signs and symptoms, these highlanders may also suffer from metabolic and cardiovascular disorders. Thus, we hypothesize that this syndrome is also associated to the loss of the cardiometabolic protection observed in healthy highlanders (HH), and therefore to a higher cardiovascular risk (CVR). The aim of the present work was to evaluate the association between EE and CVR calculated using the Framingham General CVR Score and between EE and CVR factors in male highlanders. This cross-sectional study included 342 males from Cerro de Pasco, Peru at 4340 m (HH = 209, CMS = 133). Associations were assessed by multiple logistic regressions adjusted for potential confounders (BMI, pulse oxygen saturation and age). The adjusted models show that the odds of high CVR (>20%) in highlanders with EE was 3.63 times the odds in HH (CI 95%:1.22–10.78; p = 0.020), and that EE is associated to hypertension, elevated fasting serum glucose, insulin resistance, and elevated fasting serum triglycerides. Our results suggest that individuals who suffer from EE are at increased risk of developing cardiovascular events compared with their healthy counterparts.
Collapse
Affiliation(s)
- Noemí Corante
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Cecilia Anza-Ramírez
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Rómulo Figueroa-Mujíca
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - José Luis Macarlupú
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Gustavo Vizcardo-Galindo
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Grzegorz Bilo
- 2 Department of Medicine and Surgery, University of Milano-Bicocca , Milano, Italy .,3 Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano , Milano, Italy
| | - Gianfranco Parati
- 2 Department of Medicine and Surgery, University of Milano-Bicocca , Milano, Italy .,3 Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano , Milano, Italy
| | - Jorge L Gamboa
- 4 Division of Clinical Pharmacology, Vanderbilt University Medical Center , Nashville, Tennessee
| | - Fabiola León-Velarde
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| | - Francisco C Villafuerte
- 1 Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima , Perú
| |
Collapse
|
34
|
Endothelial markers in high altitude induced systemic hypertension (HASH) at moderate high altitude. Med J Armed Forces India 2017; 73:363-369. [PMID: 29386711 DOI: 10.1016/j.mjafi.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 09/22/2017] [Indexed: 01/09/2023] Open
Abstract
Background Chronic intermittent hypoxia is known to induce systemic arterial hypertension whereas chronic hypoxia causes pulmonary arterial hypertension. High altitude (HA) induced systemic hypertension (HASH) in previously normotensive lowlanders following acclimatisation and prolonged stay at moderate HA is a commonly encountered medical problem. HASH has been attributed to increased sympathetic discharge. Endothelial dysfunction (ED) is implicated in hypertension in the plains hence this study was conducted in HA. This is relevant especially because of the established role of ED in the aetiopathogenesis of HA illnesses. Since hypoxia may induce ED, we aimed at studying the association of endothelial dysfunction with HASH in temporary residents at HA. Methods In this case-control single-centre study, we evaluated ED, by measuring endothelial molecular markers, soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (VCAM-1), vascular endothelial growth factor (VEGF) and endothelial selectin (E-Selectin) in 24 cases with HASH and 25 age, sex matched normotensive controls at moderate high altitude (11,500 ft). Results The levels of sICAM-1 (patients: 214.3 ± 34.2 μg/L, controls: 196.2 ± 28.5 μg/L; p = 0.049) and VCAM-1 (patients 766.1 ± 123.4 ng/mL, controls: 668.6 + 117.6 ng/mL; p = 0.007) were statistically higher in the patient group. However, VEGF and E-Selectin were not significantly different between the groups. sICAM-1 significantly correlated with levels of systolic and diastolic blood pressure (r = 0.401, p = 0.003 and 0.486, p = 0.000) respectively. Conclusion HASH is associated with endothelial dysfunction in form of raised levels of sICAM-1 and VCAM-1.
Collapse
|
35
|
Moore LG. Measuring high-altitude adaptation. J Appl Physiol (1985) 2017; 123:1371-1385. [PMID: 28860167 DOI: 10.1152/japplphysiol.00321.2017] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 08/15/2017] [Accepted: 08/15/2017] [Indexed: 12/12/2022] Open
Abstract
High altitudes (>8,000 ft or 2,500 m) provide an experiment of nature for measuring adaptation and the physiological processes involved. Studies conducted over the past ~25 years in Andeans, Tibetans, and, less often, Ethiopians show varied but distinct O2 transport traits from those of acclimatized newcomers, providing indirect evidence for genetic adaptation to high altitude. Short-term (acclimatization, developmental) and long-term (genetic) responses to high altitude exhibit a temporal gradient such that, although all influence O2 content, the latter also improve O2 delivery and metabolism. Much has been learned concerning the underlying physiological processes, but additional studies are needed on the regulation of blood flow and O2 utilization. Direct evidence of genetic adaptation comes from single-nucleotide polymorphism (SNP)-based genome scans and whole genome sequencing studies that have identified gene regions acted upon by natural selection. Efforts have begun to understand the connections between the two with Andean studies on the genetic factors raising uterine blood flow, fetal growth, and susceptibility to Chronic Mountain Sickness and Tibetan studies on genes serving to lower hemoglobin and pulmonary arterial pressure. Critical for future studies will be the selection of phenotypes with demonstrable effects on reproductive success, the calculation of actual fitness costs, and greater inclusion of women among the subjects being studied. The well-characterized nature of the O2 transport system, the presence of multiple long-resident populations, and relevance for understanding hypoxic disorders in all persons underscore the importance of understanding how evolutionary adaptation to high altitude has occurred.NEW & NOTEWORTHY Variation in O2 transport characteristics among Andean, Tibetan, and, when available, Ethiopian high-altitude residents supports the existence of genetic adaptations that improve the distribution of blood flow to vital organs and the efficiency of O2 utilization. Genome scans and whole genome sequencing studies implicate a broad range of gene regions. Future studies are needed using phenotypes of clear relevance for reproductive success for determining the mechanisms by which naturally selected genes are acting.
Collapse
Affiliation(s)
- Lorna G Moore
- Division of Reproductive Sciences, Department of Obstetrics & Gynecology, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| |
Collapse
|
36
|
Rationale and design of the Hunting for the off-target propertIes of Ticagrelor on Endothelial function and other Circulating biomarkers in Humans (HI-TECH) trial. Am Heart J 2017. [PMID: 28625369 DOI: 10.1016/j.ahj.2017.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Among the 3 approved oral P2Y12 inhibitors for the treatment for patients with acute coronary syndrome (ACS), ticagrelor, but not prasugrel or clopidogrel, has been associated with off-target properties, such as improved endothelial-dependent vasomotion and increased adenosine plasma levels. METHODS The HI-TECH study (NCT02587260) is a multinational, randomized, open-label, crossover study with a Latin squares design, conducted at 5 European sites, in which patients free from recurrent ischemic or bleeding events ≥30 days after a qualifying ACS were allocated to sequentially receive a 30 ± 5-day treatment with prasugrel, clopidogrel, and ticagrelor in random order. The primary objective was to evaluate whether ticagrelor, at treatment steady state (ie, after 30 ± 5 days of drug administration), as compared with both clopidogrel and prasugrel, is associated with an improved endothelial function, assessed with peripheral arterial tonometry. Thirty-six patients undergoing evaluable endothelial function assessment for each of the assigned P2Y12 inhibitor were needed to provide 90% power to detect a 10% relative change of the reactive hyperemia index in the ticagrelor group. CONCLUSION The HI-TECH study is the first randomized, crossover study aiming to ascertain whether ticagrelor, when administered at approved regimen in post-ACS patients, improves endothelial function as compared with both clopidogrel and prasugrel.
Collapse
|
37
|
Revera M, Salvi P, Faini A, Giuliano A, Gregorini F, Bilo G, Lombardi C, Mancia G, Agostoni P, Parati G. Renin–Angiotensin–Aldosterone System Is Not Involved in the Arterial Stiffening Induced by Acute and Prolonged Exposure to High Altitude. Hypertension 2017; 70:75-84. [DOI: 10.1161/hypertensionaha.117.09197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 02/17/2017] [Accepted: 04/29/2017] [Indexed: 11/16/2022]
Abstract
This randomized, double-blind, placebo-controlled study was designed to explore the effects of exposure to very high altitude hypoxia on vascular wall properties and to clarify the role of renin–angiotensin–aldosterone system inhibition on these vascular changes. Forty-seven healthy subjects were included in this study: 22 randomized to telmisartan (age, 40.3±10.8 years; 7 women) and 25 to placebo (age, 39.3±9.8 years; 7 women). Tests were performed at sea level, pre- and post-treatment, during acute exposure to 3400 and 5400-m altitude (Mt. Everest Base Camp), and after 2 weeks, at 5400 m. The effects of hypobaric hypoxia on mechanical properties of large arteries were assessed by applanation tonometry, measuring carotid–femoral pulse wave velocity, analyzing arterial pulse waveforms, and evaluating subendocardial oxygen supply/demand index. No differences in hemodynamic changes during acute and prolonged exposure to 5400-m altitude were found between telmisartan and placebo groups. Aortic pulse wave velocity significantly increased with altitude (
P
<0.001) from 7.41±1.25 m/s at sea level to 7.70±1.13 m/s at 3400 m and to 8.52±1.59 m/s at arrival at 5400 m (
P
<0.0001), remaining elevated during prolonged exposure to this altitude (8.41±1.12 m/s;
P
<0.0001). Subendocardial oxygen supply/demand index significantly decreased with acute exposure to 3400 m: from 1.72±0.30 m/s at sea level to 1.41±0.27 m/s at 3400 m (
P
<0.001), remaining significantly although slightly less reduced after reaching 5400 m (1.52±0.33) and after prolonged exposure to this altitude (1.53±0.25;
P
<0.001). In conclusion, the acute exposure to hypobaric hypoxia induces aortic stiffening and reduction in subendocardial oxygen supply/demand index. Renin–angiotensin–aldosterone system does not seem to play any significant role in these hemodynamic changes.
Clinical Trial Registration—
URL:
https://www.clinicaltrialsregister.eu/
. Unique identifier: 2008-000540-14.
Collapse
Affiliation(s)
- Miriam Revera
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Paolo Salvi
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Andrea Faini
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Andrea Giuliano
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Francesca Gregorini
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Grzegorz Bilo
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Carolina Lombardi
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Giuseppe Mancia
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Piergiuseppe Agostoni
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| | - Gianfranco Parati
- From the Department of Cardiovascular, Neural, and Metabolic Sciences, Istituto Auxologico Italiano, Milan (M.R., P.S., A.F., A.G., F.G., G.B., C.L., G.M., G.P.); Department of Medicine and Surgery, Università di Milano-Bicocca, Italy (G.B., G.M., G.P.); Centro Cardiologico Monzino, Milan, Italy (P.A.); and Department of Clinical Sciences and Community Health, Cardiovascular Section, Università degli Studi di Milano, Italy (P.A.)
| |
Collapse
|
38
|
Scherrer U, Verges S. Sleep apnoea and pulmonary hypertension in high-altitude dwellers: more than an association? Eur Respir J 2017; 49:49/2/1602232. [PMID: 28153872 DOI: 10.1183/13993003.02232-2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 11/20/2016] [Indexed: 11/05/2022]
Affiliation(s)
- Urs Scherrer
- Dept of Cardiology, University Hospital Bern, Bern, Switzerland.,Dept of Clinical Research, University of Bern, Bern, Switzerland.,Departamento de Biología, Facultad de Ciencias, Universidad de Tarapacá, Arica, Chile
| | - Samuel Verges
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France .,Unité 1042, Institut National de la Santé et de la Recherche Médicale (INSERM), Grenoble, France
| |
Collapse
|
39
|
Latshang TD, Furian M, Aeschbacher SS, Ulrich S, Osmonov B, Mirrakhimov EM, Isakova J, Aldashev AA, Sooronbaev TM, Bloch KE. Association between sleep apnoea and pulmonary hypertension in Kyrgyz highlanders. Eur Respir J 2017; 49:13993003.01530-2016. [PMID: 28007792 DOI: 10.1183/13993003.01530-2016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/21/2016] [Indexed: 02/03/2023]
Abstract
This case-control study evaluates a possible association between high altitude pulmonary hypertension (HAPH) and sleep apnoea in people living at high altitude.Ninety highlanders living at altitudes >2500 m without excessive erythrocytosis and with normal spirometry were studied at 3250 m (Aksay, Kyrgyzstan); 34 healthy lowlanders living below 800 m were studied at 760 m (Bishkek, Kyrgyzstan). Echocardiography, polysomnography and other outcomes were assessed. Thirty-six highlanders with elevated mean pulmonary artery pressure (mPAP) >30 mmHg (31-42 mmHg by echocardiography) were designated as HAPH+. Their data were compared to that of 54 healthy highlanders (HH, mPAP 13-28 mmHg) and 34 healthy lowlanders (LL, mPAP 8-24 mmHg).The HAPH+ group (median age 52 years (interquartile range 47-59) had a higher apnoea-hypopnoea index (AHI) of 33.8 events·h-1 (26.9-54.6) and spent a greater percentage of the night-time with an oxygen saturation <90% (T<90; 78% (61-89)) than the HH group (median age 39 years (32-48), AHI 9.0 events·h-1 (3.6-16), T<90 33% (10-69)) and the LL group (median age 40 years (30-47), AHI 4.3 events·h-1 (1.4-12.6), T<90 0% (0-0)); p<0.007 for AHI and T<90, respectively, in HAPH+ versus others. In highlanders, multivariable regression analysis confirmed an independent association between mPAP and both AHI and T<90, when controlled for age, gender and body mass index.Pulmonary hypertension in highlanders is associated with sleep apnoea and hypoxaemia even when adjusted for age, gender and body mass index, suggesting pathophysiologic interactions between pulmonary haemodynamics and sleep apnoea.
Collapse
Affiliation(s)
- Tsogyal D Latshang
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Michael Furian
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Sayaka S Aeschbacher
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| | - Batyr Osmonov
- Dept of Respiratory, Critical Care and Sleep Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Erkin M Mirrakhimov
- Dept of Respiratory, Critical Care and Sleep Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic.,Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
| | - Jainagul Isakova
- Research Institute for Molecular Biology and Medicine, Bishkek, Kyrgyz Republic
| | - Almaz A Aldashev
- Research Institute for Molecular Biology and Medicine, Bishkek, Kyrgyz Republic
| | - Talant M Sooronbaev
- Dept of Respiratory, Critical Care and Sleep Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Konrad E Bloch
- Clinic of Pneumology and Sleep Disorders Center, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
40
|
Neumann T, Baertschi M, Vilser W, Drinda S, Franz M, Brückmann A, Wolf G, Jung C. Retinal vessel regulation at high altitudes1. Clin Hemorheol Microcirc 2016; 63:281-92. [DOI: 10.3233/ch-162041] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Thomas Neumann
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Michael Baertschi
- Department of Ophthalmology, University of Basel, Switzerland
- Eyeness AG, Bern, Switzerland
| | | | | | - Marcus Franz
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | | | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Christian Jung
- University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany
| |
Collapse
|
41
|
Villafuerte FC, Corante N. Chronic Mountain Sickness: Clinical Aspects, Etiology, Management, and Treatment. High Alt Med Biol 2016; 17:61-9. [PMID: 27218284 PMCID: PMC4913504 DOI: 10.1089/ham.2016.0031] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Villafuerte, Francisco C., and Noemí Corante. Chronic mountain sickness: clinical aspects, etiology, management, and treatment. High Alt Med Biol. 17:61–69, 2016.—Millions of people worldwide live at a high altitude, and a significant number are at risk of developing Chronic Mountain Sickness (CMS), a progressive incapacitating syndrome caused by lifelong exposure to hypoxia. CMS is characterized by severe symptomatic excessive erythrocytosis (EE; Hb ≥19 g/dL for women and Hb ≥21 g/dL for men) and accentuated hypoxemia, which are frequently associated with pulmonary hypertension. In advanced cases, the condition may evolve to cor pulmonale and congestive heart failure. Current knowledge indicates a genetic predisposition to develop CMS. However, there are important risk factors and comorbidities that may trigger and aggravate the condition. Thus, appropriate medical information on CMS is necessary to provide adequate diagnosis and healthcare to high-altitude inhabitants. After reviewing basic clinical aspects of CMS, including its definition, diagnosis, and common clinical findings, we discuss aspects of its etiology, and address its epidemiology, risk factors, and treatment.
Collapse
Affiliation(s)
- Francisco C Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia , Lima, Perú
| | - Noemí Corante
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia , Lima, Perú
| |
Collapse
|
42
|
Villafuerte FC, Corante N, Anza-Ramírez C, Figueroa-Mujíca R, Vizcardo-Galindo G, Mercado A, Macarlupú JL, León-Velarde F. Plasma soluble erythropoietin receptor is decreased during sleep in Andean highlanders with Chronic Mountain Sickness. J Appl Physiol (1985) 2016; 121:53-8. [PMID: 27125843 PMCID: PMC4967249 DOI: 10.1152/japplphysiol.00107.2016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/27/2016] [Indexed: 12/24/2022] Open
Abstract
Andean highlanders suffering from Chronic Mountain Sickness (CMS) show consistently lower levels of plasma soluble erythropoietin (Epo) receptor (sEpoR) and higher Epo-to-EpoR ratios (Epo/sEpoR) during sleep compared with their healthy counterparts. This indicates higher blood Epo availability in CMS patients and continuous nocturnal erythropoietic stimulus. Additionally, morning Epo/sEpoR and mean sleep-time SpO2 are independent main predictors of Hct. These findings support the role of the Epo system in the development of excessive erythrocytosis in CMS. Excessive erythrocytosis (EE) is the main sign of Chronic Mountain Sickness (CMS), a highly prevalent syndrome in Andean highlanders. Low pulse O2 saturation (SpO2) during sleep and serum androgens have been suggested to contribute to EE in CMS patients. However, whether these factors have a significant impact on the erythropoietin (Epo) system leading to EE is still unclear. We have recently shown that morning soluble Epo receptor (sEpoR), an endogenous Epo antagonist, is decreased in CMS patients suggesting increased Epo availability (increased Epo/sEpoR). The present study aimed to characterize the nocturnal concentration profile of sEpoR and Epo and their relationship with SpO2, Hct, and serum testosterone in healthy highlanders (HH) and CMS patients. Epo and sEpoR concentrations were evaluated every 4 h (6 PM to 6 AM) and nighttime SpO2 was continuously monitored (10 PM to 6 AM) in 39 male participants (CMS, n = 23; HH, n = 16) aged 21-65 yr from Cerro de Pasco, Peru (4,340 m). CMS patients showed higher serum Epo concentrations throughout the night and lower sEpoR from 10 PM to 6 AM. Consequently, Epo/sEpoR was significantly higher in the CMS group at every time point. Mean sleep-time SpO2 was lower in CMS patients compared with HH, while the percentage of sleep time spent with SpO2 < 80% was higher. Multiple-regression analysis showed mean sleep-time SpO2 and Epo/sEpoR as significant predictors of hematocrit corrected for potential confounders (age, body mass index, and testosterone). Testosterone levels were associated neither with Hct nor with erythropoietic factors. In conclusion, our results show sustained erythropoietic stimulus driven by the Epo system in CMS patients, further enhanced by a continuous exposure to accentuated nocturnal hypoxemia.
Collapse
Affiliation(s)
- Francisco C Villafuerte
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Noemí Corante
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cecilia Anza-Ramírez
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rómulo Figueroa-Mujíca
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gustavo Vizcardo-Galindo
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Andy Mercado
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - José Luis Macarlupú
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Fabiola León-Velarde
- Laboratorio de Fisiología Comparada, Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
43
|
Interaction of CARD14, SENP1 and VEGFA polymorphisms on susceptibility to high altitude polycythemia in the Han Chinese population at the Qinghai–Tibetan Plateau. Blood Cells Mol Dis 2016; 57:13-22. [DOI: 10.1016/j.bcmd.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/10/2015] [Accepted: 11/10/2015] [Indexed: 01/08/2023]
|
44
|
Rexhaj E, Rimoldi SF, Pratali L, Brenner R, Andries D, Soria R, Salinas C, Villena M, Romero C, Allemann Y, Lovis A, Heinzer R, Sartori C, Scherrer U. Sleep-Disordered Breathing and Vascular Function in Patients With Chronic Mountain Sickness and Healthy High-Altitude Dwellers. Chest 2016; 149:991-8. [PMID: 26540612 DOI: 10.1378/chest.15-1450] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 10/02/2015] [Accepted: 10/15/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Chronic mountain sickness (CMS) is often associated with vascular dysfunction, but the underlying mechanism is unknown. Sleep-disordered breathing (SDB) frequently occurs at high altitude. At low altitude, SDB causes vascular dysfunction. Moreover, in SDB, transient elevations of right-sided cardiac pressure may cause right-to-left shunting in the presence of a patent foramen ovale (PFO) and, in turn, further aggravate hypoxemia and pulmonary hypertension. We speculated that SDB and nocturnal hypoxemia are more pronounced in patients with CMS compared with healthy high-altitude dwellers, and are related to vascular dysfunction. METHODS We performed overnight sleep recordings, and measured systemic and pulmonary artery pressure in 23 patients with CMS (mean ± SD age, 52.8 ± 9.8 y) and 12 healthy control subjects (47.8 ± 7.8 y) at 3,600 m. In a subgroup of 15 subjects with SDB, we assessed the presence of a PFO with transesophageal echocardiography. RESULTS The major new findings were that in patients with CMS, (1) SDB and nocturnal hypoxemia was more severe (P < .01) than in control subjects (apnea-hypopnea index [AHI], 38.9 ± 25.5 vs 14.3 ± 7.8 number of events per hour [nb/h]; arterial oxygen saturation, 80.2% ± 3.6% vs 86.8% ± 1.7%, CMS vs control group), and (2) AHI was directly correlated with systemic blood pressure (r = 0.5216; P = .001) and pulmonary artery pressure (r = 0.4497; P = .024). PFO was associated with more severe SDB (AHI, 48.8 ± 24.7 vs 14.8 ± 7.3 nb/h; P = .013, PFO vs no PFO) and hypoxemia. CONCLUSIONS SDB and nocturnal hypoxemia are more severe in patients with CMS than in control subjects and are associated with systemic and pulmonary vascular dysfunction. The presence of a PFO appeared to further aggravate SDB. Closure of the PFO may improve SDB, hypoxemia, and vascular dysfunction in patients with CMS. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov.
Collapse
Affiliation(s)
- Emrush Rexhaj
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Stefano F Rimoldi
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland
| | | | - Roman Brenner
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Daniela Andries
- Center for Investigation and Research in Sleep, Lausanne-CHUV, Switzerland
| | - Rodrigo Soria
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Carlos Salinas
- Instituto Boliviano de Biologia de Altura, La Paz, Bolivia
| | | | | | - Yves Allemann
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland
| | - Alban Lovis
- Center for Investigation and Research in Sleep, Lausanne-CHUV, Switzerland
| | - Raphaël Heinzer
- Center for Investigation and Research in Sleep, Lausanne-CHUV, Switzerland
| | - Claudio Sartori
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland; Department of Internal Medicine, Lausanne-CHUV, Switzerland
| | - Urs Scherrer
- Department of Cardiology and Clinical Research, Inselspital, University of Bern, Bern, Switzerland; Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile.
| |
Collapse
|
45
|
Bonomini M, Del Vecchio L, Sirolli V, Locatelli F. New Treatment Approaches for the Anemia of CKD. Am J Kidney Dis 2016; 67:133-42. [DOI: 10.1053/j.ajkd.2015.06.030] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/29/2015] [Indexed: 12/20/2022]
|
46
|
Bruno RM, Ghiadoni L, Pratali L. Vascular adaptation to extreme conditions: The role of hypoxia. Artery Res 2016. [DOI: 10.1016/j.artres.2016.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
|
47
|
Rimoldi SF, Rexhaj E, Villena M, Salmon CS, Allemann Y, Scherrer U, Sartori C. Novel Insights into Cardiovascular Regulation in Patients with Chronic Mountain Sickness. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 903:83-100. [PMID: 27343090 DOI: 10.1007/978-1-4899-7678-9_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Studies of high-altitude populations, and in particular of maladapted subgroups, may provide important insight into underlying mechanisms involved in the pathogenesis of hypoxemia-related disease in general. Chronic mountain sickness (CMS) is a major public health problem in mountainous regions of the world affecting many millions of high-altitude dwellers. It is characterized by exaggerated chronic hypoxemia, erythrocytosis, and mild pulmonary hypertension. In later stages these patients often present with right heart failure and are predisposed to systemic cardiovascular disease, but the underlying mechanisms are poorly understood. Here, we present recent new data providing insight into underlying mechanisms that may cause these complications.
Collapse
Affiliation(s)
- Stefano F Rimoldi
- Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland.
- Department of Internal Medicine, Botnar Center for Extreme Medicine, University Hospital, Lausanne, CHUV, Switzerland.
| | - Emrush Rexhaj
- Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
- Department of Internal Medicine, Botnar Center for Extreme Medicine, University Hospital, Lausanne, CHUV, Switzerland
| | | | | | - Yves Allemann
- Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
| | - Urs Scherrer
- Department of Cardiology, Swiss Cardiovascular Center Bern, University Hospital, Bern, Switzerland
- Department of Internal Medicine, Botnar Center for Extreme Medicine, University Hospital, Lausanne, CHUV, Switzerland
- Departamento de Biología, Facultad de Ciencias, Universidad de Tarapacá, Arica, Chile
| | - Claudio Sartori
- Department of Internal Medicine, Botnar Center for Extreme Medicine, University Hospital, Lausanne, CHUV, Switzerland
| |
Collapse
|
48
|
Rimoldi SF, Ott S, Rexhaj E, de Marchi SF, Allemann Y, Gugger M, Scherrer U, Seiler C. Patent Foramen Ovale Closure in Obstructive Sleep Apnea Improves Blood Pressure and Cardiovascular Function. Hypertension 2015; 66:1050-7. [PMID: 26418025 DOI: 10.1161/hypertensionaha.115.06303] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/24/2015] [Indexed: 11/16/2022]
Abstract
UNLABELLED Obstructive sleep apnea (OSA) is a frequent syndrome characterized by intermittent hypoxemia and increased prevalence of arterial hypertension and cardiovascular morbidity. In OSA, the presence of patent foramen ovale (PFO) is associated with increased number of apneas and more severe oxygen desaturation. We hypothesized that PFO closure improves sleep-disordered breathing and, in turn, has favorable effects on vascular function and arterial blood pressure. In 40 consecutive patients with newly diagnosed OSA, we searched for PFO. After initial cardiovascular assessment, the 14 patients with PFO underwent initial device closure and the 26 without PFO served as control group. Conventional treatment for OSA was postponed for 3 months in both groups, and polysomnographic and cardiovascular examinations were repeated at the end of the follow-up period. PFO closure significantly improved the apnea-hypopnea index (ΔAHI -7.9±10.4 versus +4.7±13.1 events/h, P=0.0009, PFO closure versus control), the oxygen desaturation index (ΔODI -7.6±16.6 versus +7.6±17.0 events/h, P=0.01), and the number of patients with severe OSA decreased significantly after PFO closure (79% versus 21%, P=0.007). The following cardiovascular parameters improved significantly in the PFO closure group, although remained unchanged in controls: brachial artery flow-mediated vasodilation, carotid artery stiffness, nocturnal systolic and diastolic blood pressure (-7 mm Hg, P=0.009 and -3 mm Hg, P=0.04, respectively), blood pressure dipping, and left ventricular diastolic function. In conclusion, PFO closure in OSA patients improves sleep-disordered breathing and nocturnal oxygenation. This translates into an improvement of endothelial function and vascular stiffening, a decrease of nighttime blood pressure, restoration of the dipping pattern, and improvement of left ventricular diastolic function. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01780207.
Collapse
Affiliation(s)
- Stefano F Rimoldi
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.).
| | - Sebastian Ott
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.)
| | - Emrush Rexhaj
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.)
| | - Stefano F de Marchi
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.)
| | - Yves Allemann
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.)
| | - Matthias Gugger
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.)
| | - Urs Scherrer
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.)
| | - Christian Seiler
- From the Department of Cardiology and Clinical Research (S.F.R., E.R., S.F.d.M., Y.A., U.S., C.S.) and Department of Pneumology (S.O., M.G.), Inselspital, University Hospital, Bern, Switzerland; and Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile (U.S.).
| |
Collapse
|
49
|
Abstract
PURPOSE OF REVIEW The relationship of altitude and cold to cardiovascular risk is complex. Cold is hard to separate from altitude. This review highlights the latest information on cardiovascular disease associated with high altitude and cold; both represent unique clinical situations. RECENT FINDINGS Evolution and genetics are relevant to high altitude, with much new information available. Specific physiology explains some congenital heart disease at altitude. New reports of hematological changes associated with altitude and cold help clarify thrombosis, which is relevant to reports of very late in-stent thrombosis at altitude. Multiple cardiovascular risk factors are affected by altitude and cold, and an increased incidence of myocardial infarction occurs. There is new research on acute mountain sickness associated with inflammation with relevance for clinical study of pulmonary edema. Socioeconomics plays a part in altitude and cold effects on cardiovascular disease. In addition to acute disease, high altitude involves chronic mountain sickness with new knowledge of associated cardiovascular endothelial abnormalities. SUMMARY High altitude and cold involve acute disease, chronic disease, and public health issues. Continued research is essential to enable the best clinical management in this era of rapid worldwide travel.
Collapse
|
50
|
Brenner R, Pratali L, Rimoldi SF, Murillo Jauregui CX, Soria R, Rexhaj E, Salinas Salmón C, Villena M, Romero C, Sartori C, Allemann Y, Scherrer U. Exaggerated Pulmonary Hypertension and Right Ventricular Dysfunction in High-Altitude Dwellers With Patent Foramen Ovale. Chest 2015; 147:1072-1079. [DOI: 10.1378/chest.14-1353] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|