Right-to-left shunt in COPD at high altitude - randomized, controlled trail with dexamethasone
| Autor: | Ulan Sheraliev, Maamed Mademilov, Batyr Osmonov, Stefanie Ulrich, Sayaka S. Aeschbacher, Aijamal Tabysheva, Konrad E. Bloch, Talant Sooronbaev, Hannes Knapp, Silvia Ulrich, Michael Furian, Mona Lichtblau, Maya Bisang |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
COPD business.industry medicine.medical_treatment Right-to-left shunt Effects of high altitude on humans medicine.disease Placebo Intracardiac injection Internal medicine medicine.artery mental disorders Pulmonary artery Cardiology Medicine business Saline Dexamethasone medicine.drug |
| Zdroj: | Pulmonary Circulation and Pulmonary Vascular Disease. |
| DOI: | 10.1183/1393003.congress-2017.pa2431 |
| Popis: | Objective: To study the prevalence of right-to-left shunts (RLS) in COPD patients traveling to altitude with and without dexamethasone prophylaxis. Methods: Lowlanders with COPD, GOLD 1-2, SpO2 >93%, were randomized to Dexamethasone (4mg, bid) or placebo, starting one day before ascent from 760m and during a 3-day-stay at 3200m. RLS was assessed by saline contrast echocardiography at 760m and after the first night at 3200m by visible bubbles in the left atrium and classified as intracardiac (within 3 cardiac cycles) or intrapulmonary. Results: Of 87 patients (84% male, mean±SD age 57.0±8.8, BMI 25±4 kg/m2, FEV1 89±22%pred, SpO2 95±2%) 39 were assigned to placebo, 48 to dexamethasone. With placebo, 19/39 (49%) had RLS (11 intracardiac); with dexamethasone 23/48 (48%) had RLS (13 intracardiac), p=NS. With altitude, 12 resp. 17 patients with placebo resp. dexamethasone developed new or changed from intrapulmonary to intracardiac RLS, p = 0.018 resp. 0.011, p=NS between groups). The prevalence of RLS at 3200m was 30/39(77%) with placebo and 36/48(75%) with dexamethasone (p= NS). A higher increase in systolic pulmonary artery pressure (SPAP) but not treatment allocation was an independent predictor of new RLS development at 3200m. Independent predictors of SPAP were altitude, dexamethasone, FEV1, age and new/changed RLS. Conclusion: In lowlanders with mild COPD, travelling to 3200m increases the prevalence of RLS and Dexamethasone is not preventive. An increase in SPAP may be a cause or a consequence of RLS at altitude. |
| Databáze: | OpenAIRE |
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