Giacomo Strapazzon1, Roberto Vezzaro2, Georg Hofer3, Tomas Dal Cappello4, Emily Procter4, Karla Balkenhol4, Stefan Platzgummer5, Hermann Brugger4. 1. EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, Bolzano 39100, Italy giacomo.strapazzon@eurac.edu. 2. Department of Radiology, University Hospital of Padova, Padova, Italy. 3. Department of Anesthesiology and Critical Care Medicine, General Hospital of Silandro, Silandro, Italy. 4. EURAC Institute of Mountain Emergency Medicine, Viale Druso 1, Bolzano 39100, Italy. 5. Department of Laboratory Medicine, General Hospital of Merano, Merano, Italy.
Abstract
AIMS: Increased extravascular lung water (EVLW) is seen as B-lines on chest ultrasonography. In lowlanders ascending to altitude the time course, relationship with the patient's clinical status and factors affecting B-lines are still unclear. The aim was to monitor B-lines, clinical status and N-terminal B-type natriuretic peptide (NT-proBNP) during exposure to high altitude. METHODS AND RESULTS: Chest ultrasonography, blood samples, cardiovascular parameters, and signs and symptoms of high altitude pulmonary oedema (HAPE) were prospectively assessed in 19 participants at baseline and after ascent to 3830 m (9, 24, 48, 72 h, and 8 days) by blinded investigators. Potential confounding factors (e.g. altitude variations, physical effort) were minimized. Generalized estimating equations were used to analyse factors associated with B-lines. B-lines changed with exposure to altitude (P = 0.006) in a parabolic-like pattern within the first 72 h; 10 of 18 participants (55.6%) had >5 B-lines at 24 h. B-lines were correlated with the number of signs and symptoms (partial coefficient = 0.372, P = 0.001). B-lines were associated with time (P = 0.038), sex (P = 0.013), and SpO2 (P = 0.042), but not with NT-proBNP (P = 0.546). The participant with a clinical diagnosis of HAPE had 23 B-lines. CONCLUSION: B-lines during exposure to altitude seem to reflect the individual response to hypobaric hypoxia and represent clinically relevant alterations at high altitude, also in patients with HAPE. Similar to previous studies, our results support a non-cardiogenic aetiology of B-lines. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Increased extravascular lung water (EVLW) is seen as B-lines on chest ultrasonography. In lowlanders ascending to altitude the time course, relationship with the patient's clinical status and factors affecting B-lines are still unclear. The aim was to monitor B-lines, clinical status and N-terminal B-type natriuretic peptide (NT-proBNP) during exposure to high altitude. METHODS AND RESULTS: Chest ultrasonography, blood samples, cardiovascular parameters, and signs and symptoms of high altitude pulmonary oedema (HAPE) were prospectively assessed in 19 participants at baseline and after ascent to 3830 m (9, 24, 48, 72 h, and 8 days) by blinded investigators. Potential confounding factors (e.g. altitude variations, physical effort) were minimized. Generalized estimating equations were used to analyse factors associated with B-lines. B-lines changed with exposure to altitude (P = 0.006) in a parabolic-like pattern within the first 72 h; 10 of 18 participants (55.6%) had >5 B-lines at 24 h. B-lines were correlated with the number of signs and symptoms (partial coefficient = 0.372, P = 0.001). B-lines were associated with time (P = 0.038), sex (P = 0.013), and SpO2 (P = 0.042), but not with NT-proBNP (P = 0.546). The participant with a clinical diagnosis of HAPE had 23 B-lines. CONCLUSION: B-lines during exposure to altitude seem to reflect the individual response to hypobaric hypoxia and represent clinically relevant alterations at high altitude, also in patients with HAPE. Similar to previous studies, our results support a non-cardiogenic aetiology of B-lines. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Giacomo Strapazzon; Matiram Pun; Tomas Dal Cappello; Emily Procter; Piergiorgio Lochner; Hermann Brugger; Antonio Piccoli Journal: High Alt Med Biol Date: 2017-10-16 Impact factor: 1.981
Authors: Matiram Pun; Sara E Hartmann; Michael Furian; Adrienna M Dyck; Lara Muralt; Mona Lichtblau; Patrick R Bader; Jean M Rawling; Silvia Ulrich; Konrad E Bloch; Marc J Poulin Journal: Front Physiol Date: 2018-06-04 Impact factor: 4.566