Chronic Thromboembolic Pulmonary Hypertension, Pulmonary Artery Hypertension, Pulmonary Vascular Disorder
Conditions
Keywords
pulmonary hypertension, hypoxia, supplemental oxygen, 6-minute walk distance
Brief summary
To study the effect of SOT in patients with pulmonary vascular diseases (PVD) defined as pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension (PH) who permanently live \>2500m on pulmonary artery pressure (PAP) and other hemodynamics by echocardiography and in relation to blood gases at 2840m with and without SOT.
Detailed description
Patients with PVD diagnosed with precapillary PH with right heart catheterization and classified to groups 1 and 4 (PAH or CTEPH) who permanently live at HA \>2500 (PVDHA) will have echocardiografy to assess PAP, cardiac output and other hemodynamics and arterial blood gas to assess SaO2, PaO2 and PaCO2 near their living altitude in Quito at 2840m whilst breathing ambient air or SOT at 10l/min flow via a face mask with reservoir.
Interventions
Mobile oxygen via pressurized bottle or mobile oxygen concentrator will be applied
OTHERSham Oxygen therapy
Patients will reveice pressurized air via a nasal cannula
Sponsors
University of Zurich
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
OTHER
Masking
SINGLE (Subject)
Masking description
Sham SOT (placebo, ambient hypoxic air at 2840m) versus high-flow oxygen 10l/min both via a facial mask with reservoir will be applied
Intervention model description
Each participant works as its own perfect control
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Adult patients 18-80 years old of both genders, * Residence \> 2500m of altitude * diagnosed with precapillary PH (mean pulmonary artery pressure (mPAP) \>20 mmHg, pulmonary artery wedge pressure (PAWP) ≤15 mmHg and pulmonary vascular resistance (PVR) ≥2 wood units (WU) by right heart catheterization) with PH being classified as PAH or CTEPH according to guidelines * Patients stable on therapy * New York Heart Association (NYHA) functional class I-III * Provided written informed consent to participate in the study.
Exclusion criteria
* Age \<18 years or \>80 years * unstable condition * Patients who cannot follow the study investigations, patient permanently living \< 2500m. * Patients with moderate to severe concomitant lung disease (FEV1\<70% or forced vital capacity \<70%), severe parenchymal lung disease, severe smokers (\>20 cigarettes/day) * Severely hypoxemic patients at Quito permanently have persistent oxygen saturation by pulseoximetry (SpO2) \<80% on ambient air. * Patients with chronic mountain sickness (Hemoglobin \> 19 g/dl in women, \>21 g/dl in men) * Patient with a non-corrected ventricular septum defect * Relevant concomitant other disease of the heart, kidney, liver, blood (anemia hemoglobin\<11 g/dl)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pulmonary Artery Pressure with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Change in PAP in mmHg assessed by echocardiography with SOT compared to ambient air (placebo) 10l/min via facial mask |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in right to left heart diameter ratio with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Change in right to left heart diameter ratio assessed by echocardiography with SOT compared to ambient air (placebo) 10l/min via facial mask |
| Change in tricuspid annular plane systolic excursion (TAPSE) with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Change in tricuspid annular plane systolic excursion (TAPSE) with SOT compared to ambient air (placebo) 10l/min via facial mask |
| Change in right atrial area with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Change in right atrial area by echocardiography with SOT compared to ambient air (placebo) 10l/min via facial mask |
| Change in Cardiac Output with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Change in cardiac output (l/min) assessed by echocardiography with SOT compared to ambient air (placebo) 10l/min via facial mask |
| Change in ph by arterial blood gases with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Changes in ph by arterial blood gases SaO2, PaO2, PaCO2 with SOT compared to ambient air (placebo) 10l/min via facial mask |
| Change in PaO2 by arterial blood gases with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Changes in PaO2 by arterial blood gases with SOT compared to ambient air (placebo) 10l/min via facial mask |
| Change in PaCO2 by arterial blood gases with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Changes in PaCO2 by arterial blood gases with SOT compared to ambient air (placebo) 10l/min via facial mask |
| Change in right heart strain with SOT vs. placebo | at 15 min of breathing ambient air or supplemental oxygen | Change in in right heart strain by echocardiography with SOT compared to ambient air (placebo) 10l/min via facial mask |
Countries
Switzerland
Outcome results
None listed