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Grimm M, Ziegler L, Seglias A, Mademilov M, Magdieva K, Mirzalieva G, Taalaibekova A, Suter S, Schneider SR, Zoller F, Bissig V, Reinhard L, Bauer M, Müller J, Ulrich TL, Carta AF, Bader PR, Bitos K, Reiser AE, Champigneulle B, Ashyralieva D, Scheiwiller PM, Ulrich S, Sooronbaev TM, Furian M, Bloch KE. SARS-CoV-2 Transmission during High-Altitude Field Studies. High Alt Med Biol 2024. [PMID: 38634740 DOI: 10.1089/ham.2023.0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Grimm, Mirjam, Lucie Ziegler, Annina Seglias, Maamed Mademilov, Kamila Magdieva, Gulzada Mirzalieva, Aijan Taalaibekova, Simone Suter, Simon R. Schneider, Fiona Zoller, Vera Bissig, Lukas Reinhard, Meret Bauer, Julian Müller, Tanja L. Ulrich, Arcangelo F. Carta, Patrick R. Bader, Konstantinos Bitos, Aurelia E. Reiser, Benoit Champigneulle, Damira Ashyralieva, Philipp M. Scheiwiller, Silvia Ulrich, Talant M. Sooronbaev, Michael Furian, and Konrad E. Bloch. SARS-CoV-2 Transmission during High-Altitude Field Studies. High Alt Med Biol. 00:00-00, 2024. Background: Throughout the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, virus transmission during clinical research was of concern. Therefore, during high-altitude field studies performed in 2021, we took specific COVID-19 precautions and investigated the occurrence of SARS-CoV-2 infection. Methods: From May to September 2021, we performed studies in patients with chronic obstructive pulmonary disease (COPD) and in healthy school-age children in Kyrgyzstan in high-altitude facilities at 3,100 m and 3,250 m and at 760 m. The various implemented COVID-19 safety measures included systematic SARS-CoV-2 rapid antigen testing (RAT). Main outcomes were SARS-CoV-2-RAT-positive rate among participants and staff at initial presentation (prevalence) and SARS-CoV-2-RAT-positive conversion during and within 10 days after studies (incidence). Results: Among 338 participants and staff, SARS-CoV-2-RAT-positive prevalence was 15 (4.4%). During mean ± SD duration of individual study participation of 3.1 ± 1.0 day and within 10 days, RAT-positive conversion occurred in 1/237(0.4%) participants. Among staff working in studies for 31.5 ± 29.3 days, SARS-CoV-2-RAT-positive conversion was 11/101(10.9%). In all 338 individuals involved in the studies over the course of 15.6 weeks, the median SARS-CoV-2-RAT-positive incidence was 0.00%/week (quartiles 0.00; 0.64). Over the same period, the median background incidence among the total Kyrgyz population of 6,636 million was 0.06%/week (0.03; 0.11), p = 0.013 (Wilcoxon rank sum test). Conclusions: Taking precautions by implementing specific safety measures, SARS-CoV-2 transmission during clinical studies was very rare, and the SARS-CoV-2 incidence among participants and staff was lower than that in the general population during the same period. The results are reassuring and may help in decision-making on the conduct of clinical research in similar settings.
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Affiliation(s)
- Mirjam Grimm
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Lucie Ziegler
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Annina Seglias
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Maamed Mademilov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Kamila Magdieva
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Gulzada Mirzalieva
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Aijan Taalaibekova
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Simone Suter
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Simon R Schneider
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Fiona Zoller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Vera Bissig
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Lukas Reinhard
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Meret Bauer
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Julian Müller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Tanja L Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Arcangelo F Carta
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Patrick R Bader
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Konstantinos Bitos
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Aurelia E Reiser
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | | | - Damira Ashyralieva
- National Institute of Public Health, Ministry of Health, Bishkek, Kyrgyz Republic
| | - Philipp M Scheiwiller
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Talant M Sooronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital of Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland
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Reimann L, Mayer L, Schneider SR, Schwarz EI, Müller J, Titz A, Furian M, Carta AF, Etienne H, Battilana B, Saxer S, Pfammatter T, Frauenfelder T, Opitz I, Ulrich S, Lichtblau M. Change in Right-to-Left Shunt Fraction in Patients with Chronic Thromboembolic Pulmonary Hypertension after Pulmonary Endarterectomy. J Cardiovasc Dev Dis 2023; 10:442. [PMID: 37998500 PMCID: PMC10672130 DOI: 10.3390/jcdd10110442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Pulmonary endarterectomy (PEA) is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension (CTEPH) with accessible lesions. Breathing pure oxygen (hyperoxia) during right heart catheterization (RHC) allows for the calculation of the right-to-left shunt fraction (Qs/Qt). In the absence of intracardiac shunt, Qs/Qt can be used as a marker of ventilation-perfusion mismatch in patients with CTEPH. This study involved investigating Qs/Qt after PEA and its relation to other disease-specific outcomes. STUDY DESIGN AND METHODS This study is a retrospective study that focuses on patients with operable CTEPH who had Qs/Qt assessment during RHC before and 1 year after PEA. Additionally, 6 min walking distance (6MWD), WHO functional class (WHO-FC), and NT-proBNP were assessed to calculate a four-strata risk score. RESULTS Overall, 16 patients (6 females) with a median age of 66 years (quartiles 55; 74) were included. After PEA, an improvement in mean pulmonary artery pressure (38 [32; 41] to 24 [18; 28] mmHg), pulmonary vascular resistance (5.7 [4.0; 6.8] to 2.5 [1.4; 3.8] WU), oxygen saturation (92 [88; 93]% to 94 [93; 95]%), WHO-FC, and risk score was observed (all p < 0.05). No improvement in median Qs/Qt could be detected (13.7 [10.0; 17.5]% to 13.0 [11.2; 15.6]%, p = 0.679). A total of 7 patients with improved Qs/Qt had a significant reduction in risk score compared to those without improved Qs/Qt. CONCLUSION PEA did not alter Qs/Qt assessed after 1 year in operable CTEPH despite an improvement in hemodynamics and risk score, potentially indicating a persistent microvasculopathy. In patients whose shunt fraction improved with PEA, the reduced shunt was associated with an improvement in risk score.
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Affiliation(s)
- Lena Reimann
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Laura Mayer
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Simon Raphael Schneider
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Esther I. Schwarz
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Julian Müller
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Anna Titz
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Arcangelo F. Carta
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Harry Etienne
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Bianca Battilana
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Stéphanie Saxer
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
- Department of Health, Eastern Switzerland University of Applied Sciences, 9001 St. Gallen, Switzerland
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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3
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Bauer M, Müller J, Schneider SR, Buenzli S, Furian M, Ulrich T, Carta AF, Bader PR, Lichtblau M, Taalaibekova A, Raimberdiev M, Champigneulle B, Sooronbaev T, Bloch KE, Ulrich S. Hypoxia-altitude simulation test to predict altitude-related adverse health effects in COPD patients. ERJ Open Res 2023; 9:00488-2022. [PMID: 36923563 PMCID: PMC10009702 DOI: 10.1183/23120541.00488-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background/aims Amongst numerous travellers to high altitude (HA) are many with the highly prevalent COPD, who are at particular risk for altitude-related adverse health effects (ARAHE). We then investigated the hypoxia-altitude simulation test (HAST) to predict ARAHE in COPD patients travelling to altitude. Methods This prospective diagnostic accuracy study included 75 COPD patients: 40 women, age 58±9 years, forced expiratory volume in 1 s (FEV1) 40-80% pred, oxygen saturation measured by pulse oximetry (S pO2 ) ≥92% and arterial carbon dioxide tension (P aCO2 ) <6 kPa. Patients underwent baseline evaluation and HAST, breathing normobaric hypoxic air (inspiratory oxygen fraction (F IO2 ) of 15%) for 15 min, at low altitude (760 m). Cut-off values for a positive HAST were set according to British Thoracic Society (BTS) guidelines (arterial oxygen tension (P aO2 ) <6.6 kPa and/or S pO2 <85%). The following day, patients travelled to HA (3100 m) for two overnight stays where ARAHE development including acute mountain sickness (AMS), Lake Louise Score ≥4 and/or AMS score ≥0.7, severe hypoxaemia (S pO2 <80% for >30 min or 75% for >15 min) or intercurrent illness was observed. Results ARAHE occurred in 50 (66%) patients and 23 out of 75 (31%) were positive on HAST according to S pO2 , and 11 out of 64 (17%) according to P aO2 . For S pO2 /P aO2 we report a sensitivity of 46/25%, specificity of 84/95%, positive predictive value of 85/92% and negative predictive value of 44/37%. Conclusion In COPD patients ascending to HA, ARAHE are common. Despite an acceptable positive predictive value of the HAST to predict ARAHE, its clinical use is limited by its insufficient sensitivity and overall accuracy. Counselling COPD patients before altitude travel remains challenging and best focuses on early recognition and treatment of ARAHE with oxygen and descent.
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Affiliation(s)
- Meret Bauer
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Julian Müller
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Simon R. Schneider
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Simone Buenzli
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Michael Furian
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Tanja Ulrich
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Arcangelo F. Carta
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Patrick R. Bader
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Mona Lichtblau
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Ajian Taalaibekova
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Madiiar Raimberdiev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Benoit Champigneulle
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, CHU Grenoble Alpes, Grenoble, France
| | - Talant Sooronbaev
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
- National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyz Republic
| | - Konrad E. Bloch
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
| | - Silvia Ulrich
- University of Zurich and University Hospital of Zurich, Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss-Kyrgyz High Altitude Medicine and Research Initiative, Zurich, Switzerland, and Bishkek, Kyrgyz Republic
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Berlier C, Saxer S, Lichtblau M, Schneider SR, Schwarz EI, Furian M, Bloch KE, Carta AF, Ulrich S. Influence of Upright Versus Supine Position on Resting and Exercise Hemodynamics in Patients Assessed for Pulmonary Hypertension. J Am Heart Assoc 2022; 11:e023839. [PMID: 35156392 PMCID: PMC9245795 DOI: 10.1161/jaha.121.023839] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
The aim of the present work was to study the influence of body position on resting and exercise pulmonary hemodynamics in patients assessed for pulmonary hypertension (PH).
Methods and Results
Data from 483 patients with suspected PH undergoing right heart catheterization for clinical indications (62% women, age 61±15 years, 246 precapillary PH, 48 postcapillary PH, 106 exercise PH, 83 no PH) were analyzed; 213 patients (main cohort, years 2016–2018) were examined at rest in upright (45°) and supine position, such as under upright exercise. Upright exercise hemodynamics were compared with 270 patients (historical cohort) undergoing supine exercise with the same protocol. Upright versus supine resting data revealed a lower mean pulmonary artery pressure 31±14 versus 32±13 mm Hg, pulmonary artery wedge pressure 11±4 versus 12±5 mm Hg, and cardiac index 2.9±0.7 versus 3.1±0.8 L/min per m
2
, and higher pulmonary vascular resistance 4.1±3.1 versus 3.9±2.8 Wood
P
<0.001. Exercise data upright versus supine revealed higher work rates (53±26 versus 33±22 watt), and adjusting for differences in work rate and baseline values, higher end‐exercise mean pulmonary artery pressure (52±19 versus 45±16 mm Hg,
P
=0.001), similar pulmonary artery wedge pressure and cardiac index, higher pulmonary vascular resistance (5.4±3.7 versus 4.5±3.4 Wood units,
P
=0.002), and higher mean pulmonary artery pressure/cardiac output (7.9±4.7 versus 7.1±4.1 Wood units,
P
=0.001).
Conclusions
Body position significantly affects resting and exercise pulmonary hemodynamics with a higher pulmonary vascular resistance of about 10% in upright versus supine position at rest and end‐exercise, and should be considered and reported when assessing PH.
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Affiliation(s)
- Charlotte Berlier
- Department of Pulmonology University Hospital Zürich Zürich Switzerland
| | - Stéphanie Saxer
- Department of Pulmonology University Hospital Zürich Zürich Switzerland
| | - Mona Lichtblau
- Department of Pulmonology University Hospital Zürich Zürich Switzerland
| | | | - Esther I. Schwarz
- Department of Pulmonology University Hospital Zürich Zürich Switzerland
| | - Michael Furian
- Department of Pulmonology University Hospital Zürich Zürich Switzerland
| | - Konrad E. Bloch
- Department of Pulmonology University Hospital Zürich Zürich Switzerland
- Centre for Integrative Human PhysiologyUniversity of Zürich Zürich Switzerland
| | | | - Silvia Ulrich
- Department of Pulmonology University Hospital Zürich Zürich Switzerland
- Centre for Integrative Human PhysiologyUniversity of Zürich Zürich Switzerland
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5
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Carta AF, Lichtblau M, Berlier C, Saxer S, Schneider SR, Schwarz EI, Furian M, Bloch KE, Ulrich S. The Impact of Breathing Hypoxic Gas and Oxygen on Pulmonary Hemodynamics in Patients With Pulmonary Hypertension. Front Med (Lausanne) 2022; 9:791423. [PMID: 35223898 PMCID: PMC8878983 DOI: 10.3389/fmed.2022.791423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPure oxygen breathing (hyperoxia) may improve hemodynamics in patients with pulmonary hypertension (PH) and allows to calculate right-to-left shunt fraction (Qs/Qt), whereas breathing normobaric hypoxia may accelerate hypoxic pulmonary vasoconstriction (HPV). This study investigates how hyperoxia and hypoxia affect mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) in patients with PH and whether Qs/Qt influences the changes of mPAP and PVR.Study Design and MethodsAdults with pulmonary arterial or chronic thromboembolic PH (PAH/CTEPH) underwent repetitive hemodynamic and blood gas measurements during right heart catheterization (RHC) under normoxia [fractions of inspiratory oxygen (FiO2) 0.21], hypoxia (FiO2 0.15), and hyperoxia (FiO2 1.0) for at least 10 min.ResultsWe included 149 patients (79/70 PAH/CTEPH, 59% women, mean ± SD 60 ± 17 years). Multivariable regressions (mean change, CI) showed that hypoxia did not affect mPAP and cardiac index, but increased PVR [0.4 (0.1–0.7) WU, p = 0.021] due to decreased pulmonary artery wedge pressure [−0.54 (−0.92 to −0.162), p = 0.005]. Hyperoxia significantly decreased mPAP [−4.4 (−5.5 to −3.3) mmHg, p < 0.001] and PVR [−0.4 (−0.7 to −0.1) WU, p = 0.006] compared with normoxia. The Qs/Qt (14 ± 6%) was >10 in 75% of subjects but changes of mPAP and PVR under hyperoxia and hypoxia were independent of Qs/Qt.ConclusionAcute exposure to hypoxia did not relevantly alter pulmonary hemodynamics indicating a blunted HPV-response in PH. In contrast, hyperoxia remarkably reduced mPAP and PVR, indicating a preserved vasodilator response to oxygen and possibly supporting the oxygen therapy in patients with PH. A high proportion of patients with PH showed increased Qs/Qt, which, however, was not associated with changes in pulmonary hemodynamics in response to changes in FiO2.
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6
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Duknic M, Lichtblau M, Saxer S, Berlier C, Schneider SR, Schwarz EI, Carta AF, Furian M, Bloch KE, Ulrich S. Comparison of Repetitive Cardiac Output Measurements at Rest and End-Exercise by Direct Fick Using Pulse Oximetry vs. Blood Gases in Patients With Pulmonary Hypertension. Front Med (Lausanne) 2021; 8:776956. [PMID: 34888330 PMCID: PMC8649780 DOI: 10.3389/fmed.2021.776956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Exact and simultaneous measurements of mean pulmonary artery pressure (mPAP) and cardiac output (CO) are crucial to calculate pulmonary vascular resistance (PVR), which is essential to define pulmonary hypertension (PH). Simultaneous measurements of mPAP and CO are not feasible using the direct Fick (DF) method, due to the necessity to sample blood from the catheter-tip. We evaluated a modified DF method, which allows simultaneous measurement of mPAP and CO without needing repetitive blood samples. Methods: Twenty-four patients with pulmonary arterial or chronic thromboembolic PH had repetitive measurements of CO at rest and end-exercise during three phases of a crossover trial. CO was assessed by the original DF method using oxygen uptake, measured by a metabolic unit, and arterial and mixed venous oxygen saturations from co-oximetry of respective blood gases served as reference. These CO measurements were then compared with a modified DF method using pulse oximetry at the catheter- and fingertip. Results: The bias among CO measurements by the two DF methods at rest was −0.26 L/min with limits of agreement of ±1.66 L/min. The percentage error was 28.6%. At the end-exercise, the bias between methods was 0.29 L/min with limits of agreement of ±1.54 L/min and percentage error of 16.1%. Conclusion: Direct Fick using a catheter- and fingertip pulse oximetry (DFp) is a practicable and reliable method for assessing CO in patients with PH. This method has the advantage of allowing simultaneous measurement of PAP and CO, and frequent repetitive measurements are needed during exercise. Clinical Trial Registration:https://clinicaltrials.gov/ct2/show/NCT02755259, identifier: NCT02755259.
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Affiliation(s)
- Milos Duknic
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Mona Lichtblau
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Charlotte Berlier
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Simon R Schneider
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Arcangelo F Carta
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zürich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Müller J, Lichtblau M, Saxer S, Calendo LR, Carta AF, Schneider SR, Berlier C, Furian M, Bloch KE, Schwarz EI, Ulrich S. Effect of Breathing Oxygen-Enriched Air on Exercise Performance in Patients With Pulmonary Hypertension Due to Heart Failure With Preserved Ejection Fraction: A Randomized, Placebo-Controlled, Crossover Trial. Front Med (Lausanne) 2021; 8:692029. [PMID: 34395475 PMCID: PMC8357069 DOI: 10.3389/fmed.2021.692029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate the effects of breathing oxygen-enriched air (oxygen) on exercise performance in patients with pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF). Methods: Ten patients with PH-HFpEF (five women, age 60 ± 9 y, mPAP 37 ± 14 mmHg, PAWP 18 ± 2 mmHg, PVR 3 ± 3 WU, resting SpO2 98 ± 2%) performed two-cycle incremental exercise tests (IET) and two constant-work-rate exercise test (CWRET) at 75% maximal work-rate (Wmax), each with ambient air (FiO2 0.21) and oxygen (FiO2 0.5) in a randomized, single-blinded, cross-over design. The main outcomes were the change in Wmax (IET) and cycling time (CWRET) with oxygen vs. air. Blood gases at rest and end-exercise, dyspnea by Borg CR10 score at end-exercise; continuous SpO2, minute ventilation (V'E), carbon dioxide output (V'CO2), and cerebral and quadricep muscle tissue oxygenation (CTO and QMTO) were measured. Results: With oxygen vs. air, Wmax (IET) increased from 94 ± 36 to 99 ± 36 W, mean difference (95% CI) 5.4 (0.9–9.8) W, p = 0.025, and cycling time (CWRET) from 532 ± 203 to 680 ± 76 s, +148 (31.8–264) s, p = 0.018. At end-exercise with oxygen, Borg dyspnea score and V'E/V'CO2 were lower, whereas PaO2 and end-tidal PaCO2 were higher. Other parameters were unchanged. Conclusion: Patients with PH-HFpEF not revealing resting hypoxemia significantly improved their exercise performance while breathing oxygen-enriched air along with less subjective dyspnea sensation, a better blood oxygenation, and an enhanced ventilatory efficiency. Future studies should investigate whether prolonged training with supplemental oxygen would increase the training effect and, potentially, daily activity for PH-HFpEF patients. Clinical Trial Registration: [clinicaltrials.gov], identifier [NCT04157660].
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Affiliation(s)
- Julian Müller
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Mona Lichtblau
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Stéphanie Saxer
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Luigi-Riccardo Calendo
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Arcangelo F Carta
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Simon R Schneider
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Charlotte Berlier
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Michael Furian
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Konrad E Bloch
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland.,Centre for Integrative Human Physiology, University of Zürich, Zürich, Switzerland
| | - Esther I Schwarz
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland
| | - Silvia Ulrich
- Pulmonary Clinic, University Hospital Zürich, Zürich, Switzerland.,Faculty of Medicine, University of Zürich, Zürich, Switzerland.,Centre for Integrative Human Physiology, University of Zürich, Zürich, Switzerland
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Lichtblau M, Berlier C, Saxer S, Carta AF, Mayer L, Groth A, Bader PR, Schneider SR, Furian M, Schwarz EI, Swenson ER, Bloch KE, Ulrich S. Acute Hemodynamic Effect of Acetazolamide in Patients With Pulmonary Hypertension Whilst Breathing Normoxic and Hypoxic Gas: A Randomized Cross-Over Trial. Front Med (Lausanne) 2021; 8:681473. [PMID: 34368187 PMCID: PMC8341560 DOI: 10.3389/fmed.2021.681473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/24/2021] [Indexed: 01/30/2023] Open
Abstract
Aims: To test the acute hemodynamic effect of acetazolamide in patients with pulmonary hypertension (PH) under ambient air and hypoxia. Methods: Patients with pulmonary arterial or chronic thromboembolic PH (PAH/CTEPH) undergoing right heart catheterization were included in this randomized, placebo-controlled, double-blinded, crossover trial. The main outcome, pulmonary vascular resistance (PVR), further hemodynamics, blood- and cerebral oxygenation were measured 1 h after intravenous administration of 500 mg acetazolamide or placebo-saline on ambient air (normoxia) and at the end of breathing hypoxic gas (FIO2 0.15, hypoxia) for 15 min. Results: 24 PH-patients, 71% men, mean ± SD age 59 ± 14 years, BMI 28 ± 5 kg/m2, PVR 4.7 ± 2.1 WU participated. Mean PVR after acetazolamide vs. placebo was 5.5 ± 3.0 vs. 5.3 ± 3.0 WU; mean difference (95% CI) 0.2 (−0.2–0.6, p = 0.341). Heart rate was higher after acetazolamide (79 ± 12 vs. 77 ± 11 bpm, p = 0.026), pH was lower (7.40 ± 0.02 vs. 7.42 ± 0.03, p = 0.002) but PaCO2 and PaO2 remained unchanged while cerebral tissue oxygenation increased (71 ± 6 vs. 69 ± 6%, p = 0.017). In acute hypoxia, acetazolamide decreased PVR by 0.4 WU (0.0–0.9, p = 0.046) while PaO2 and PaCO2 were not changed. No adverse effects occurred. Conclusions: In patients with PAH/CTEPH, i.v. acetazolamide did not change pulmonary hemodynamics compared to placebo after 1 hour in normoxia but it reduced PVR after subsequent acute exposure to hypoxia. Our findings in normoxia do not suggest a direct acute pulmonary vasodilator effect of acetazolamide. The reduction of PVR during hypoxia requires further corroboration. Whether acetazolamide improves PH when given over a prolonged period by stimulating ventilation, increasing oxygenation, and/or altering vascular inflammation and remodeling remains to be investigated.
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Affiliation(s)
- Mona Lichtblau
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Charlotte Berlier
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Arcangelo F Carta
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Laura Mayer
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Groth
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Patrick R Bader
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Simon R Schneider
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Furian
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Esther I Schwarz
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Erik R Swenson
- Division of Pulmonary, Critical Care and Sleep Medicine, VA Puget Sound Health Care System, University of Washington, Seattle, WA, United States
| | - Konrad E Bloch
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Clinic of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Lichtblau M, Bader PR, Carta AF, Furian M, Muralt L, Saxer S, Hartmann SE, Rawling JM, Poulin MJ, Bloch KE, Ulrich S. Extravascular lung water and cardiac function assessed by echocardiography in healthy lowlanders during repeated very high-altitude exposure. Int J Cardiol 2021; 332:166-174. [PMID: 33775791 DOI: 10.1016/j.ijcard.2021.03.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND High-altitude pulmonary edema is associated with elevated systolic pulmonary artery pressure (sPAP) and increased extravascular lung water (EVLW). We investigated sPAP and EVLW during repeated exposures to high altitude (HA). METHODS Healthy lowlanders underwent two identical 7-day HA-cycles, where subjects slept at 2900 m and spent 4-8 h daily at 5050 m, separated by a weeklong break at low altitude (LA). Echocardiography and EVLW by B-lines were measured at 520 m (baseline, LA1), on day one, two and six at 5050 m (HA1-3) and after descent (LA2). RESULTS We included 21 subjects (median 25 years, body mass index 22 kg/m2, SpO2 98%). SPAP rose from 21 mmHg at LA1 to 38 mmHg at HA1, decreased to 30 mmHg at HA3 (both p < 0.05 vs LA1) and normalized at 20 mmHg at LA2 (p = ns vs LA1). B-lines increased from 0 at LA1 to 6 at HA2 and 7 at HA3 (both p < 0.05 vs LA1) and receded to 1 at LA2 (p = ns vs LA1). Overall, in cycle two, sPAP did not differ (mean difference (95% confidence interval) -0.2(-2.3 to 1.9) mmHg, p = 0.864) but B-lines were more prevalent (+2.3 (1.4-3.1), p < 0.001) compared to cycle 1. Right ventricular systolic function decreased significantly but minimally at 5050 m. CONCLUSIONS Exposure to 5050 m induced a rapid increase in sPAP. B-lines rose during prolonged exposures to 5050 m, despite gradual decrease in sPAP, indicating excessive hydrostatic pressure might not be solely responsible for EVLW-development. Repeated HA-exposure had no acclimatization effect on EVLW. This may affect workers needing repetitive ascents to altitude and could indicate greater B-line development upon repeated exposure.
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Affiliation(s)
- Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Patrick R Bader
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Arcangelo F Carta
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Lara Muralt
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Stéphanie Saxer
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Sara E Hartmann
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Jean M Rawling
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Marc J Poulin
- Department of Physiology and Pharmacology and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Zurich, Switzerland.
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Carta AF, Bitos K, Furian M, Mademilov M, Sheraliev U, Marazhapov NH, Lichtblau M, Schneider SR, Sooronbaev T, Bloch KE, Ulrich S. ECG changes at rest and during exercise in lowlanders with COPD travelling to 3100 m. Int J Cardiol 2020; 324:173-179. [PMID: 32987054 DOI: 10.1016/j.ijcard.2020.09.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND The incidence and magnitude of cardiac ischemia and arrhythmias in patients with chronic obstructive pulmonary disease (COPD) during exposure to hypobaric hypoxia is insufficiently studied. We investigated electrocardiogram (ECG) markers of ischemia at rest and during incremental exercise testing (IET) in COPD-patients travelling to 3100 m. STUDY DESIGN AND METHODS Lowlanders (residence <800 m) with COPD (forced volume in the first second of expiration (FEV1) 40-80% predicted, oxygen saturation (SpO2) ≥92%, arterial partial pressure of carbon dioxide (PaCO2) <6 kPa at 760 m) aged 18 to 75 years, without history of cardiovascular disease underwent 12‑lead ECG recordings at rest and during cycle IET to exhaustion at 760 m and after acute exposure of 3 h to 3100 m. Mean ST-changes in ECGs averaged over 10s were analyzed for signs of ischemia (≥1 mm horizontal or downsloping ST-segment depression) at rest, peak exercise and 2-min recovery. RESULTS 80 COPD-patients (51% women, mean ± SD, 56.2 ± 9.6 years, body mass index (BMI) 27.0 ± 4.5 kg/m2, SpO2 94 ± 2%, FEV1 63 ± 10% prEd.) were included. At 3100 m, 2 of 53 (3.8%) patients revealed ≥1 mm horizontal ST-depression during IET vs 0 of 64 at 760 m (p = 0.203). Multivariable mixed regression revealed minor but significant ST-depressions associated with altitude, peak exercise or recovery and rate pressure product (RPP) in multiple leads. CONCLUSION In this study, ECG recordings at rest and during IET in COPD-patients do not suggest an increased incidence of signs of ischemia with ascent to 3100 m. Whether statistically significant ST changes below the standard threshold of clinical relevance detected in multiple leads reflect a risk of ischemia during prolonged exposure remains to be elucidated.
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Affiliation(s)
- Arcangelo F Carta
- Department of Respiratory Medicine, University Hospital Zurich, Switzerland
| | - Konstantinos Bitos
- Department of Respiratory Medicine, University Hospital Zurich, Switzerland
| | - Michael Furian
- Department of Respiratory Medicine, University Hospital Zurich, Switzerland
| | - Maamed Mademilov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Ulan Sheraliev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Nuriddin H Marazhapov
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Mona Lichtblau
- Department of Respiratory Medicine, University Hospital Zurich, Switzerland
| | - Simon R Schneider
- Department of Respiratory Medicine, University Hospital Zurich, Switzerland
| | - Talant Sooronbaev
- Department of Respiratory Medicine, National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Konrad E Bloch
- Department of Respiratory Medicine, University Hospital Zurich, Switzerland
| | - Silvia Ulrich
- Department of Respiratory Medicine, University Hospital Zurich, Switzerland.
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