Deceleration Capacity and Periodic Repolarization Dynamics As Predictors of Acute Mountain Sickness

Hamm, Wolfgang; Kassem, Sari; Stülpnagel, Lukas von; Maier, Florian; Klemm, Mathias; Schüttler, Dominik; Grabher, Felix; Weckbach, Ludwig T.; Hüber, Bruno; Bauer, Axel; Rizas, Konstantinos D.; Brunner, Stefan

doi:10.1089/ham.2020.0131

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Independent risk factors for AMS, such as genetics, sex, body mass index (BMI), and the ascending altitude and velocity, have been confirmed in previous studies (Santantonio et al, 2014;Luks et al, 2017). Moreover, previous findings have also demonstrated that AMS may be affected by the baseline and HA-induced changes of cardiovascular indices (Lanfranchi et al, 2005;Hamm et al, 2020;Ke et al, 2020). However, conflicting results are often reported and the exact mechanism of AMS still needs to be fully elucidated.…”

Section: Introductionmentioning

confidence: 76%

Cardiovascular Indicators of Systemic Circulation and Acute Mountain Sickness: An Observational Cohort Study

et al. 2021

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Background: Acute high-altitude (HA) exposure results in blood pressure (BP) and cardiac function variations in most subjects, some of whom suffer from acute mountain sickness (AMS). Several previous studies have found that cardiovascular function indicators are potentially correlated with AMS.Objectives: This study aims to examine HA-induced cardiovascular adaptations in AMS patients and compare them with healthy subjects. It also aims to investigate the relationship between cardiovascular function indicators and AMS, as well as to provide some insightful information about the prevention and treatment of AMS.Methods: Seventy-two subjects were enrolled in this cohort study. All the subjects ascended Litang (4,100 m above sea level). They were monitored by a 24-h ambulatory blood pressure (ABP) device and underwent echocardiography examination within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS.Results: Acute mountain sickness group consisted of more women (17 [60.7%] vs. 10 [22.7%], p = 0.001) and fewer smokers (5 [17.9%] vs. 23 [52.3%], p = 0.003). Compared with subjects without AMS, subjects with AMS had lower pulse pressure (PP) (daytime PP, 45.23 ± 7.88 vs. 52.14 ± 4.75, p < 0.001; nighttime PP, 42.81 ± 5.92 vs. 49.39 ± 7.67, p < 0.001) and lower effective arterial elastance (Ea) (1.53 ± 0.24 vs. 1.73 ± 0.39, p = 0.023). Multivariate regression indicated that female sex (OR = 0.23, p = 0.024), lower daytime PP (OR = 0.86, p = 0.004), and lower Ea (OR = 0.03, p = 0.015) at low altitude (LA) were independent risk factors for AMS. Combined daytime PP and Ea at LA had a high predictive value for AMS (AUC = 0.873; 95% CI: 0.789–0.956). Correlation analysis showed that AMS-induced headache correlated with daytime PP (R = −0.401, p < 0.001) and nighttime PP at LA (R = −0.401, p < 0.001).Conclusion: Our study demonstrated that AMS patients had a lower PP and Ea at LA. These baseline indicators of vasodilation at LA were closely associated with AMS, which may explain the higher headache severity in subjects with higher PP at LA.

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Section: Introductionmentioning

confidence: 76%

Cardiovascular Indicators of Systemic Circulation and Acute Mountain Sickness: An Observational Cohort Study

et al. 2021

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“…A mean±SD value of 1.50±1.0 deg 2 was assumed in CTL, because PRD varies in healthy humans from 1.50 to 3.64 deg 2 among different studies and relatively low PRD values were expected due to anesthesia. 30 , 31 , 32 , 33 A minimum increase of 75% was expected between CTL and pigs with IHF based on the observed PRD in patients with infarction. 27 Applying a 2‐sample t test, a sample size of 11 pigs per group was estimated to analyze the primary end point.…”

Section: Methodsmentioning

confidence: 95%

Biomarker Periodic Repolarization Dynamics Indicates Enhanced Risk for Arrhythmias and Sudden Cardiac Death in Myocardial Infarction in Pigs

Bauer,

Vlcek,

Pauly

et al. 2024

JAHA

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Background Periodic repolarization dynamics (PRD) is an electrocardiographic biomarker that captures repolarization instability in the low frequency spectrum and is believed to estimate the sympathetic effect on the ventricular myocardium. High PRD indicates an increased risk for postischemic sudden cardiac death (SCD). However, a direct link between PRD and proarrhythmogenic autonomic remodeling has not yet been shown. Methods and Results We investigated autonomic remodeling in pigs with myocardial infarction (MI)–related ischemic heart failure induced by balloon occlusion of the left anterior descending artery (n=17) compared with pigs without MI (n=11). Thirty days after MI, pigs demonstrated enhanced sympathetic innervation in the infarct area, border zone, and remote left ventricle paralleled by altered expression of autonomic marker genes/proteins. PRD was enhanced 30 days after MI compared with baseline (pre‐MI versus post‐MI: 1.75±0.30 deg 2 versus 3.29±0.79 deg 2 , P <0.05) reflecting pronounced autonomic alterations on the level of the ventricular myocardium. Pigs with MI‐related ventricular fibrillation and SCD had significantly higher pre‐MI PRD than pigs without tachyarrhythmias, suggesting a potential role for PRD as a predictive biomarker for ischemia‐related arrhythmias (no ventricular fibrillation versus ventricular fibrillation: 1.50±0.39 deg 2 versus 3.18±0.53 deg 2 [ P <0.05]; no SCD versus SCD: 1.67±0.32 deg 2 versus 3.91±0.63 deg 2 [ P <0.01]). Conclusions We demonstrate that ischemic heart failure leads to significant proarrhythmogenic autonomic remodeling. The concomitant elevation of PRD levels in pigs with ischemic heart failure and pigs with MI‐related ventricular fibrillation/SCD suggests PRD as a biomarker for autonomic remodeling and as a potential predictive biomarker for ventricular arrhythmias/survival in the context of MI.

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“…Some maladaptive individuals may suffer acute mountain sickness (AMS), which is characterized by headache and other related symptoms ( 3 , 4 ). Previous studies have indicated that certain cardiovascular system indicators including electrocardiogram changes and cardiac systolic function are related to the occurrence and development of AMS ( 5 , 6 ). Moreover, excessive elevation of arterial BP is detrimental to the body and is considered to be closely associated with AMS ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Blood Pressure Load: An Effective Indicator of Systemic Circulation Status in Individuals With Acute Altitude Sickness

Chen

Sun

et al. 2022

Front. Cardiovasc. Med.

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Background: Acute high altitude (HA) exposure results in blood pressure (BP) variations in most subjects. Previous studies have demonstrated that higher BP is potentially correlated with acute mountain sickness (AMS). The BP load may be of clinical significance regarding systemic circulation status.Objectives: This study aimed to examine HA-induced BP changes in patients with AMS compared to those in healthy subjects. Further, we provided clinical information about the relationship between variations in 24-h ambulatory parameters (BP level, BP variability, and BP load) and AMS.Methods: Sixty-nine subjects were enrolled and all participants ascended Litang (4,100 m above sea level). They were monitored using a 24-h ambulatory blood pressure device and underwent echocardiography within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS.Results: The AMS group comprised more women than men [15 (65.2%) vs. 13 (28.3%), P < 0.001] and fewer smokers [4 (17.4%) vs. 23 (50.0%), P = 0.009]. The AMS group exhibited significant increases in 24-h BP compared to the non-AMS group (24-h SBP variation: 10.52 ± 6.48 vs. 6.03 ± 9.27 mmHg, P = 0.041; 24-h DBP variation: 8.70 ± 4.57 vs. 5.03 ± 4.98 mmHg, P = 0.004). The variation of mean 24-h cBPL (cumulative BP load) (mean 24-h cSBPL: 10.58 ± 10.99 vs. 4.02 ± 10.58, P = 0.016; 24-h mean cDBPL: 6.03 ± 5.87 vs. 2.89 ± 4.99, P = 0.034) was also obviously higher in AMS subjects than in non-AMS subjects after HA exposure. 24-h mean cSBPL variation (OR = 1.07, P = 0.024) and 24-h mean cDBPL variation (OR = 1.14, P = 0.034) were independent risk factors of AMS. Moreover, variation of 24-h mean cSBPL showed a good correlation with AMS score (R = 0.504, P < 0.001).Conclusions: Our study demonstrated that patients with AMS had higher BP and BP load changes after altitude exposure than healthy subjects. Excessive BP load variations were associated with AMS. Thus, BP load could be an effective indicator regarding systemic circulation status of AMS.

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Deceleration Capacity and Periodic Repolarization Dynamics As Predictors of Acute Mountain Sickness

Cited by 6 publications

References 21 publications

Cardiovascular Indicators of Systemic Circulation and Acute Mountain Sickness: An Observational Cohort Study

Cardiovascular Indicators of Systemic Circulation and Acute Mountain Sickness: An Observational Cohort Study

Biomarker Periodic Repolarization Dynamics Indicates Enhanced Risk for Arrhythmias and Sudden Cardiac Death in Myocardial Infarction in Pigs

Blood Pressure Load: An Effective Indicator of Systemic Circulation Status in Individuals With Acute Altitude Sickness

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