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Cardiac safety of prolonged hypoxia exposure in fully revascularized patients with prior myocardial infarction

Hönemann, J. and Gerlach, D.A. and Hoffmann, F. and Kramer, T. and Weis, H. and Zaha, V. and Sadek, H. and Reuter, H. and Baldus, S. and Levine, B.D. and Jordan, J. and Tank, J. and Limper, U. (2022) Cardiac safety of prolonged hypoxia exposure in fully revascularized patients with prior myocardial infarction. In: Clinical Research in Cardiology. 88. Jahrestagung der Deutschen Gesellschaft für Kardiologie, 20.-23. April 2022, Mannheim, Deutschland. doi: 10.1007/s00392-022-02002-5.

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Abstract

BACKGROUND Treatments improving cardiac regeneration could transform clinical management of ischemic cardiomyopathy. In mice with experimental myocardial infarction, prolonged normobaric hypoxia exposure corresponding to around 8,000 m altitude induced myocardial mitosis and improved left ventricular function. We determined whether a similar approach could be feasible and safe in patients. METHODS We included four highly selected men with myocardial infarction in their history (3x STEMI, 1x NSTEMI). Patients had coronary 1-vessel disease with a fully revascularized LAD stenosis as culprit lesion. The study, which was conducted at the :envihab facility, included a two-day baseline, 19 days normobaric hypoxia, and a two-day recovery period. Atmospheric oxygen was gradually lowered to 11.8% and maintained at that level for 4 days. We obtained transthoracic echocardiography, magnetic resonance imaging of the heart and the brain at baseline, during 11.8% oxygen, and recovery, and daily 12-lead ECG. RESULTS Except for symptoms of acute mountain sickness, which improved over time, hypoxia was well tolerated and severe adverse reactions did not occur. Echocardiography revealed hypoxia-induced pulmonary hypertension, which rapidly abated during recovery. Mean left ventricular ejection fraction was 50.7±11.0 % (mean±SD) at baseline, 57.6±11.2 % during hypoxia, and 57.3±11.2 following recovery (p=0.045). Cardiac magnetic resonance imaging confirmed the finding. In patients with elevated NTproBNP at baseline, the measurement was decreased during hypoxia and following recovery. Troponin I concentrations remained in the reference range throughout the study. CONCLUSIONS In a small number of fully revascularized, highly selected patients with prior myocardial infarction, prolonged exposure to substantial normobaric hypoxia was feasible and safe despite reversible increases in pulmonary artery pressure. In fact, left ventricular ejection fraction and NTproBNP were improved during and following hypoxia exposure. Our findings provide critical information for further studies assessing influences of hypoxia on cardiac regeneration in human beings.

Item URL in elib:https://elib.dlr.de/190435/
Document Type:Conference or Workshop Item (Poster)
Title:Cardiac safety of prolonged hypoxia exposure in fully revascularized patients with prior myocardial infarction
Authors:
AuthorsInstitution or Email of AuthorsAuthor's ORCID iDORCID Put Code
Hönemann, J.Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, KölnUNSPECIFIEDUNSPECIFIED
Gerlach, D.A.Cardiovascular Aerospace Medicine Department, Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germanyhttps://orcid.org/0000-0001-7044-6065UNSPECIFIED
Hoffmann, F.Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, KölnUNSPECIFIEDUNSPECIFIED
Kramer, T.Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, KölnUNSPECIFIEDUNSPECIFIED
Weis, H.Nuklearmedizin, Universitätsklinikum Köln, KölnUNSPECIFIEDUNSPECIFIED
Zaha, V.Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, DallasUNSPECIFIEDUNSPECIFIED
Sadek, H.Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, DallasUNSPECIFIEDUNSPECIFIED
Reuter, H.Klinik für Innere Medizin, Evangelisches Klinikum Köln Weyertal, KölnUNSPECIFIEDUNSPECIFIED
Baldus, S.Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, KölnUNSPECIFIEDUNSPECIFIED
Levine, B.D.Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USAUNSPECIFIEDUNSPECIFIED
Jordan, J.UNSPECIFIEDhttps://orcid.org/0000-0003-4518-0706UNSPECIFIED
Tank, J.UNSPECIFIEDhttps://orcid.org/0000-0002-5672-1187UNSPECIFIED
Limper, U.UNSPECIFIEDhttps://orcid.org/0000-0001-9927-4180UNSPECIFIED
Date:2022
Journal or Publication Title:Clinical Research in Cardiology
Refereed publication:Yes
Open Access:No
Gold Open Access:No
In SCOPUS:No
In ISI Web of Science:No
DOI:10.1007/s00392-022-02002-5
Status:Published
Keywords:Cardiac safety; prolonged hypoxia; revascularized patients; prior myocardial infarction
Event Title:88. Jahrestagung der Deutschen Gesellschaft für Kardiologie
Event Location:Mannheim, Deutschland
Event Type:national Conference
Event Dates:20.-23. April 2022
Organizer:Deutsche Gesellschaft für Kardiologie
HGF - Research field:Aeronautics, Space and Transport
HGF - Program:Space
HGF - Program Themes:Research under Space Conditions
DLR - Research area:Raumfahrt
DLR - Program:R FR - Research under Space Conditions
DLR - Research theme (Project):R - CardioBrain
Location: Köln-Porz
Institutes and Institutions:Institute of Aerospace Medicine
Institute of Aerospace Medicine > Cardiovascular Medicine in Aerospace
Institute of Aerospace Medicine > Leitungsbereich ME
Deposited By: Schrage, Larissa
Deposited On:22 Nov 2022 13:22
Last Modified:22 Nov 2022 13:22

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