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The effect of hyperbaric oxygenation therapy on myocardial function

Authors:
  • Assaf Harofeh Medical Center, affiliated to the Tel Aviv University
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Hyperbaric oxygenation therapy is successfully implemented for the treatment of several disorders. Data on the effect of hyperbaric oxygenation on echocardiographic parameters in asymptomatic patients is limited. The current study sought to evaluate the effect of hyperbaric oxygenation therapy on echocardiographic parameters in asymptomatic patients. Thirty-one consecutive patients underwent a 60-sessions course of hyperbaric oxygenation therapy in an attempt to improve cognitive impairment. In all subjects, echocardiography examination was performed before and after a course of hyperbaric oxygenation therapy. Conventional and speckle tracking imaging parameters were calculated and analyzed. The mean age was 70 ± 9.5 years, 28 [90%] were males. History of coronary artery disease was present in 12 [39%]. 94% suffered from hypertension, 42% had diabetes mellitus. Baseline wall motion abnormalities were found in eight patients, however, global ejection fraction was within normal limits. During the study, ejection fraction [EF], increased from 60.71 ± 6.02 to 62.29 ± 5.19%, p = 0.02. Left ventricular end systolic volume [LVESV], decreased from 38.08 ± 13.30 to 35.39 ± 13.32 ml, p = 0.01. Myocardial performance index [MPi] improved, from 0.29 ± 0.07 to 0.26 ± 0.08, p = 0.03. Left ventricular [LV] global longitudinal strain increased from − 19.31 ± 3.17% to − 20.16 ± 3.34%, p = 0.036 due to improvement in regional strain in the apical and antero-septal segments. Twist increased from 18.32 ± 6.61° to 23.12 ± 6.35° p = 0.01, due to improvement in the apical rotation, from 11.76 ± 4.40° to 16.10 ± 5.56°, p = 0.004. Hyperbaric oxygen therapy appears to improve left ventricular function, especially in the apical segments, and is associated with better cardiac performance. If our results are confirmed in further studies, HBOT can be used in many patients with heart failure and systolic dysfunction.
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The International Journal of Cardiovascular Imaging (2020) 36:833–840
https://doi.org/10.1007/s10554-020-01773-0
ORIGINAL PAPER
The eect ofhyperbaric oxygenation therapy onmyocardial function
MarinaLeitman1,3· ShaiEfrati2,3,4· ShmuelFuchs1,3· AmirHadanny2,3,4· ZviVered1,3
Received: 25 May 2019 / Accepted: 7 January 2020 / Published online: 17 January 2020
© Springer Nature B.V. 2020
Abstract
Hyperbaric oxygenation therapy is successfully implemented for the treatment of several disorders. Data on the effect of
hyperbaric oxygenation on echocardiographic parameters in asymptomatic patients is limited. The current study sought to
evaluate the effect of hyperbaric oxygenation therapy on echocardiographic parameters in asymptomatic patients. Thirty-one
consecutive patients underwent a 60-sessions course of hyperbaric oxygenation therapy in an attempt to improve cognitive
impairment. In all subjects, echocardiography examination was performed before and after a course of hyperbaric oxy-
genation therapy. Conventional and speckle tracking imaging parameters were calculated and analyzed. The mean age was
70 ± 9.5years, 28 [90%] were males. History of coronary artery disease was present in 12 [39%]. 94% suffered from hyperten-
sion, 42% had diabetes mellitus. Baseline wall motion abnormalities were found in eight patients, however, global ejection
fraction was within normal limits. During the study, ejection fraction [EF], increased from 60.71 ± 6.02 to 62.29 ± 5.19%,
p = 0.02. Left ventricular end systolic volume [LVESV], decreased from 38.08 ± 13.30 to 35.39 ± 13.32ml, p = 0.01. Myocar-
dial performance index [MPi] improved, from 0.29 ± 0.07 to 0.26 ± 0.08, p = 0.03. Left ventricular [LV] global longitudinal
strain increased from − 19.31 ± 3.17% to − 20.16 ± 3.34%, p = 0.036 due to improvement in regional strain in the apical and
antero-septal segments. Twist increased from 18.32 ± 6.61° to 23.12 ± 6.35° p = 0.01, due to improvement in the apical rota-
tion, from 11.76 ± 4.40° to 16.10 ± 5.56°, p = 0.004. Hyperbaric oxygen therapy appears to improve left ventricular function,
especially in the apical segments, and is associated with better cardiac performance. If our results are confirmed in further
studies, HBOT can be used in many patients with heart failure and systolic dysfunction.
Keywords Hyperbaric oxygenation· Echocardiography· Cardiac function
Introduction
Hyperbaric oxygen therapy (HBOT) includes the inhalation
of 100% oxygen at pressures exceeding 1 atmosphere abso-
lute in order to enhance the amount of oxygen dissolved
in the body tissues. During HBOTtreatment, the arterial
O2tension typically exceeds 2000mmHg, and levels of
200–400mmHg occur in tissues [1]. HBOT has been applied
worldwide mostly for chronic non-healing wounds and for
diving accidents. In recent years, there is growing evidence
on the regenerative effects of HBOT. It is now realized, that
the combined action of both hyperoxia and hyperbaric pres-
sure, leads to significant improvement in tissue oxygenation
while targeting both oxygen and pressure sensitive genes,
resulting in improved mitochondrial metabolism with anti-
apoptotic and anti-inflammatory effects [218]. Moreover,
these genes induce stem cells proliferation, augmented cir-
culating levels of endothelial progenitor cells and angiogen-
esis factors, which induce angiogenesis and improve blood
flow in the ischemic area [28]. However, in human stud-
ies, which were mainly focused on brain regeneration and
neuroplasticity, it had been shown, that these effects require
prolonged hyperbaric series of 40–60 sessions [6, 1921].
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s1055 4-020-01773 -0) contains
supplementary material, which is available to authorized users.
* Marina Leitman
marina.leitman@gmail.com
1 Department ofCardiology, Shamir Medical Center, Zerifin,
Israel
2 Sagol Center forHyperbaric Medicine andResearch, Shamir
Medical Center, Zerifin, Israel
3 Sackler School ofMedicine, Tel Aviv University, TelAviv,
Israel
4 Sagol School ofNeuroscience, Tel Aviv University, TelAviv,
Israel
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Hyperbaric oxygenation (HBO), widely used for the repair of chronic ulcers in diabetic patients [9][10][11], is now emerging as a promising adjunctive therapy for cardiovascular diseases [12]. HBO consists of the supply of 100% oxygen at pressures above atmospheric [13]. ...
... HBO consists of the supply of 100% oxygen at pressures above atmospheric [13]. In addition to attenuate hypoxia and facilitate fatty acid metabolism [14], HBO is believed to elicit signaling pathways necessary for tissue maintenance and restoration [12]. For instance, animal studies using HBO have found decreased circulating levels of tumor necrosis factor-α (TNF-α) after myocardial damage [15], and increased vascular endothelial growth factor (VEGF) expression in the injured skeletal muscle [16] and diabetic wounds [17], as well as modulation of MMP expression in different tissues [13]. ...
... Nonetheless, a specific cardioprotective role of HBO therapy in controlling the expression of these bioactive proteins in diabetes remains to be demonstrated. Data from pre-post, non-controlled studies showed increase in LV ejection fraction in a heterogeneous cohort of asymptomatic participants undergoing HBO therapy [12] and, in diabetics, it was found improved LV relaxation [10] and electrical activity [11]. In addition, HBO improved LV end diastolic volume in diabetic rats [18]. ...
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Aims Hyperbaric oxygen (HBO) therapy has been widely used for the adjunctive treatment of diabetic wounds, and is currently known to influence left ventricular (LV) function. However, morphological and molecular repercussions of the HBO in the diabetic myocardium remain to be described. We aimed to investigate whether HBO therapy would mitigate adverse LV remodeling caused by streptozotocin (STZ)-induced diabetes. Main methods Sixty-day-old Male Wistar rats were divided into four groups: Control (n = 8), HBO (n = 7), STZ (n = 10), and STZ + HBO (n = 8). Diabetes was induced by a single STZ injection (60 mg/kg, i.p.). HBO treatment (100% oxygen at 2.5 atm absolute, 60 min/day, 5 days/week) lasted for 5 weeks. LV morphology was evaluated using histomorphometry. Gene expression analyzes were performed for LV collagens I (Col1a1) and III (Col3a1), matrix metalloproteinases 2 (Mmp2) and 9 (Mmp9), and transforming growth factor-β1 (Tgfb1). The Immunoexpression of cardiac tumor necrosis factor-α (TNF-α) and vascular endothelial growth factor (VEGF) were also quantified. Key findings HBO therapy prevented LV concentric remodeling, heterogeneous myocyte hypertrophy, and fibrosis in diabetic rats associated with attenuation of leukocyte infiltration. HBO therapy also increased Mmp2 gene expression, and inhibited the induction of Tgfb1 and Mmp9 mRNAs caused by diabetes, and normalized TNF-α and VEGF protein expression. Significance HBO therapy had protective effects for the LV structure in STZ-diabetic rats and ameliorated expression levels of genes involved in cardiac collagen turnover, as well as pro-inflammatory and pro-angiogenic signaling.
... HBOT used under different protocols yields inconsistent results in elderly subjects. In a clinical study of asymptomatic elderly, HBOT, utilized in a repeated 60 daily sessions protocol at 2 ATA, improved left ventricular and right ventricular systolic function, and resulted in better cardiac performance, while no significant changes were observed in diastolic parameters [192]. In contrast, a slight improvement in diastolic function in the elderly was previously observed after a single exposure to hyperbaric oxygen while the EF result reflecting cardiac systolic function showed a negative trend [193]. ...
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... One possible explanation is the potential relationship between oxygen concentration and mitochondrial biogenesis. Many studies have shown that dissolved oxygen or reactive oxygen species (ROS), in addition to saturated oxygen, affect mitochondrial function and structure [20,[26][27][28][29]. The mechanism of hyperbaric treatment is related to an elevation in atmospheric pressure accompanied by a high oxygen concentration. ...
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... Therefore, our study demonstrated that HBOT effectively provided cardiometabolic protection through attenuation of cardiac oxidative stress, inflammation, apoptotic cells, dysfunctional mitochondria, and increased autophagy in NDDg rats, leading to the restoration of cardiac functions in the present study (Table 2). Consistently, a recent clinical study has demonstrated that %LVEF from echocardiographic result was significantly increased in elderly men after receiving HBOT (2ATA for 90 minutes (with 5 minutes air breaks every 20 minutes), once a day, 5days per week for 60days) when compared to %LVEF before receiving HBOT [32]. ...
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