Intermittent Hypoxic-hyperoxic Training in Patients With Cardiovascular Pathology After COVID-19 Infection.

  • STATUS
    Recruiting
  • days left to enroll
    33
  • participants needed
    60
  • sponsor
    I.M. Sechenov First Moscow State Medical University
Updated on 28 May 2022
atherosclerosis
electrocardiogram
cancer
hypertension
heart failure
depression
anxiety
atrial fibrillation
diagnostic procedure
holter monitor
ischemia
b-type natriuretic peptide
fibrillation
rehabilitation therapy
conduction disorders
mental illness

Summary

Aim of this prospective, interventional, single-center, randomized study is to evaluate the efficacy and safety of intermittent hypoxic-hyperoxic training (IHHT) as a rehabilitation method in patients with cardiovascular pathology in the early period after coronavirus infection.

The study will include 60 patients with cardiovascular pathology who underwent confirmed by laboratory tests COVID-19 infection 1-3 months ago with the degree of lung lesion CT3, CT4, who were admitted to the University Clinical Hospital No. 4 of I.M. Sechenov First Moscow State Medical University. The patients will be divided into 2 groups (intervention and control groups).

Intervention group will inhale hypoxic gas mixtures (10-12% O2) followed by exposure to a hyperoxic gas mixture with 30-35% O2 5 times a week for 3 weeks, while control group will undergo a simulated IHHT.

All the patients will undergo identical laboratory and instrumental testing before IHHT, after the last IHHT procedure, in a month after the last IHHT procedure and in 6 months.

Estimated result of the study is to confirm or refute the hypothesis of the study that a three-week course of IHHT in patients with cardiovascular pathology in the early period after coronavirus infection can improve exercise tolerance, as well as the quality of life and psychoemotional status, and affect the dynamics of laboratory and instrumental parameters.

Description

Aim of this prospective, interventional, single-centered, randomized study is to evaluate the efficacy and safety of intermittent hypoxic-hyperoxic training as a rehabilitation method in patients with cardiovascular pathology in the early period after coronavirus infection.

The study will include 60 patients with cardiovascular pathology who underwent confirmed by laboratory tests COVID-19 infection (polymerase chain reaction (PCR) testing, enzyme-linked immunosorbent assay (positive result at least 1 time)) 1-3 months ago with the degree of lung lesion CT3, CT4, who were admitted to the University Clinical Hospital No. 4 of I.M. Sechenov First Moscow State Medical University.

Patients will be randomized via the random number table method into two groups, comparable by gender, age and comorbidity:

Intermittent hypoxic-hyperoxic training (intervention group) group, 30 patients who will receive 15 IHHT sessions, 40-minutes long each (5 workouts per week) for 3 weeks. Patients in the IHHT group will inhale hypoxic gas mixtures (10-12% O2) followed by exposure to a hyperoxic gas mixture with 30-35% O2.

A control group of 30 patients will undergo a simulated IHHT course with the same "exposure" time and number of sessions. Patients of this group will breathe normoxic gas mixture using the same equipment; ordinary humidified air is supplied through the mask during the entire session.

Patients eligible for inclusion will undergo the following investigations:

  • Anamnesis and complaints collection; physical examination;
  • Assessment of the quality of life and psycho-emotional status using the Short Form-36 (SF36) and Hospital Anxiety and Depression Scale (HADS) questionnaires, as well as the six-minute walk test;
  • General and biochemical blood tests , urine analysis, , determination of markers of inflammation (ferritin, C-reactive protein, D-dimer, fibrinogen, interleukin-1, interleukin-6, interleukin-18 and tumor necrosis factor), the level of Endothelin-1 and nitric oxide (NO) in the blood;
  • Electrocardiography, a flow mediated dilatation procedure for endothelial function assessment,transthoracic echocardiography to identify the structural and functional features of the myocardium, spiroergometry to determine the patient's oxygen consumption.

The statistical processing will be performed using the Python Software Foundation version 3.8 for Windows (Delaware, USA).

Estimated result of the study is to confirm or refute the hypothesis of the study that a three-week course of IHHT in patients with cardiovascular pathology in the early stages after suffering a coronavirus infection can improve exercise tolerance, as well as the quality of life and psychoemotional status, and affect the dynamics of laboratory and instrumental parameters.

Details
Condition COVID-19, Chronic Heart Failure, Hypertension, Arrhythmia, Conduct Disorder, Chronic Coronary Syndrome, Endothelial Dysfunction, Diastolic Dysfunction, Oxygen Consumption, Quality of Life, Exercise Tolerance
Treatment Intermittent hypoxic-hyperoxic training, Intermittent hypoxic-hyperoxic training/control
Clinical Study IdentifierNCT05379608
SponsorI.M. Sechenov First Moscow State Medical University
Last Modified on28 May 2022

Eligibility

Yes No Not Sure

Inclusion Criteria

Written informed consent to participate in the study
Age 40 and over
Male and female
One or more cardiovascular pathologies in the anamnesis
a reliably confirmed diagnosis of hypertension, stage I-III (the diagnosis was made in accordance with the National Clinical Guidelines - 2019)
stable angina pectoris I-III functional class, confirmed by complaints, anamnesis and physical examination and with the help of diagnostic tests (bicycle ergometry or daily electrocardiography monitoring)
confirmed diagnosis of arrhythmias and conduction disorders based on electrocardiography data and 24-hour Holter monitoring (premature depolarization, supraventricular tachycardia, atrial fibrillation, sick sinus syndrome, atrioventricular block I-II, bundle branch blocks)
chronic heart failure stage I-IIB, I-III functional class (New York Heart Association Functional Classification), confirmed by the presence of clinical signs and at least one of two criteria: myocardial dysfunction of left ventricle or / and an increase in the level of the N-terminal fragment of brain natriuretic peptide over 125 pg / ml
the presence of signs of systolic or diastolic dysfunction of the left ventricle according to echocardiography
COVID-19 infection confirmed by laboratory tests (polymerase chain reaction testing
enzyme-linked immunosorbent assay (positive result at least 1 time) with a CT
degree of 3 or higher
Non-inclusion criteria
Acute infectious diseases, tuberculosis
Chronic somatic diseases in the acute stage
Congenital anomalies of the heart and large vessels
Valvular heart defects (congenital and acquired)
Severe atherosclerosis of the lower extremities'vessels (chronic ischemia of the lower extremities,stage 3-4)
Acute decompensated heart failure (II-IV class according to Killip classification)
Chronic heart failure IV functional class (New York Heart Association Functional Classification classification)
Secondary arterial hypertension
Acute coronary syndrome within 4 weeks before the start of the study
Life-threatening rhythm and conduction disturbances
Bronchial asthma with the development of respiratory failure II-III degree
Acute cerebrovascular accident within the last 4 months
Chronic kidney disease (glomerular filtration rate<30 ml / min / 1.73 m2 via CKD-EPI (chronic kidney disease epidemiology collaboration) formula)
Pregnancy
Mental illness (severe dementia, schizophrenia, severe depression, manic-depressive psychosis)
Oncology, diagnosed within a year or receiving a course of radiation / chemotherapy for cancer at the present time
Severe cognitive impairment (MOS) and clinically significant anxiety and / or depression (HADS) interfering with observation
Individual intolerance to oxygen deficiency

Exclusion Criteria

Refusal to further participation in the study
Acute psychotic reactions arising in the process of the study
Exacerbation of chronic diseases, requiring a change in patient management tactics and preventing his or her further participation in the study
Clear my responses

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