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Decrease of asymmetric dimethylarginine predicts acute mountain sickness.

Markus Tannheimer1, Kerstin Hornung, Matthias Gasche

  • 1Departments of General and Thoracic Surgery, German Armed Forces Hospital of Ulm, Ulm, Germany. markus.tannheimer@arcor.de

Journal of Travel Medicine
|February 6, 2013
PubMed
Summary
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Changes in asymmetric dimethylarginine (ADMA) levels can predict acute mountain sickness (AMS) and high-altitude pulmonary edema (HAPE) risk. A decrease in ADMA indicates higher susceptibility to AMS and HAPE at high altitudes.

Area of Science:

  • Altitude Medicine
  • Cardiovascular Physiology
  • Biochemistry

Background:

  • Millions of tourists travel to high altitudes annually, risking acute mountain sickness (AMS) and high-altitude pulmonary edema (HAPE).
  • Asymmetric dimethylarginine (ADMA), a nitric oxide synthase inhibitor, is implicated in pulmonary artery pressure regulation and altitude sickness.
  • Investigating ADMA's role is crucial for understanding and predicting altitude-related illnesses.

Purpose of the Study:

  • To determine if changes in ADMA levels (Δ-ADMA) at 4000m can predict susceptibility to AMS and HAPE.
  • To correlate Δ-ADMA with pulmonary artery pressure (PAP) and hypoxia symptoms (Lake Louise Score - LLS).

Main Methods:

  • Twelve subjects were exposed to a simulated altitude of 4000m in a hypobaric chamber for two nights.

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  • ADMA serum levels, PAP (Doppler echocardiography), and LLS were measured at 2, 5, and 11 hours under normobaric and hypobaric conditions.
  • Changes in ADMA (Δ-ADMA) and PAP (Δ-PAP) were analyzed in relation to LLS.

    • Main Results:

    • Contrary to hypothesis, increased ADMA correlated with lower PAP and no AMS symptoms.
    • Decreased ADMA levels were associated with AMS and elevated PAP (>40 mmHg).
    • Early hypoxia (2 hours) showed significant relationships between Δ-ADMA, Δ-PAP, and LLS.

    Conclusions:

    • Δ-ADMA after 2 hours of hypoxia can predict LLS >5 with 80% sensitivity and 100% specificity.
    • Δ-ADMA serves as a valuable tool for assessing HAPE risk by predicting significant PAP increases.
    • Early ADMA level changes offer a predictive marker for altitude sickness severity.