Speckle Tracking Evaluation of Mild Hyperbaric Oxygen Effects on Myocardial Contractility and Ejection Function in a Patient with Severe Ischemic Cardiomyopathy: A Case Report and Physiological Discussion

Introduction: This case report focuses on the effects of mild hyperbaric oxygen therapy (mHBOT) in an over 70 years old female patient with symptomatic ischemic cardiomyopathy, severe diffuse coronary atheromasia not revascularizable by coronary angioplasty nor by aorta-coronary bypass surgery due to coronary anatomical characterizations. The patient suffered repeated episodes of heart failure resistant to pharmacological therapy (currently the patient is at the maximum anti-ischemic therapy), having an ejection fraction (EF) pre-mHBOT protocol severely reduced, seen also at speckle tracking with a marked depression of the systolic function due to marked global hypokinesis and severe dyskinesia of the antero-lateral myocardial walls, especially the apical segments. Methods: The mHBOT was performed with a medical hyperbaric chamber using the following protocol: 1.45 atm, 96 % O2, 75 min sessions, three times a week for three months. Pre- and post-mHBOT clinical values which were compared are the following: Bull’s eye speckle tracking echocardiography with longitudinal strain and color pattern, EF, Angina scale. Results: Post-mHBOT recordings showed massive improvement of myocardium contractility, from a severely dyskinetic and hypokinetic contractility to a normal kinetics, with a color shift from “blu” to “red” in the anterior and lateral segment at the bull’s eye representation accompanied by normalization of the longitudinal strain values globally and especially on the severely dysfunctional lateral and anterior segments. EF also went from being severely depressed to normality range and angina symptoms disappeared. Conclusions: The mHBOT protocol has been shown in this case report to improve myocardial function, contractility and symptomatology of the patient. Post-protocol EF dramatically increased with improvement of myocardial functions as seen with speckle tracking recordings at ultrasound examination of the myocardium, with normalization of kinetics of the myocardial segments. The improvements remained at the 6 months post-HBOT follow-up cardiac check. This case report highlighted the importance and possible future application in patients with ischemic cardiomyopathy of mHBOT, a replicable, low cost and highly efficacious therapy.