Acute Changes in Pulmonary Artery Pressures Due to Exercise and Exposure to High Altitude Do Not Cause Left Ventricular Diastolic Dysfunction

Bernheim, Alain; Kiencke, Stephanie; Fischler, Manuel; Dorschner, Lorenz; Debrunner, Johann; Mairbäurl, Heimo; Maggiorini, Marco; Rocca, Hans Peter Brunner–La

doi:10.1378/chest.07-0297

Cited by 33 publications

(13 citation statements)

References 23 publications

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“…This finding is in accordance with previous studies in healthy adults (1,4,11). The acute increase in pulmonary artery pressure during highaltitude exposure induced a change in left ventricular diastolic function, which, as previously described in adults (1), was directly correlated with the severity of pulmonary hypertension.…”

Section: Discussionsupporting

confidence: 93%

Pulmonary artery pressure and cardiac function in children and adolescents after rapid ascent to 3,450 m

Allemann

Stüber

Marchi

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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High-altitude destinations are visited by increasing numbers of children and adolescents. High-altitude hypoxia triggers pulmonary hypertension that in turn may have adverse effects on cardiac function and may induce life-threatening high-altitude pulmonary edema (HAPE), but there are limited data in this young population. We, therefore, assessed in 118 nonacclimatized healthy children and adolescents (mean ± SD; age: 11 ± 2 yr) the effects of rapid ascent to high altitude on pulmonary artery pressure and right and left ventricular function by echocardiography. Pulmonary artery pressure was estimated by measuring the systolic right ventricular to right atrial pressure gradient. The echocardiography was performed at low altitude and 40 h after rapid ascent to 3,450 m. Pulmonary artery pressure was more than twofold higher at high than at low altitude (35 ± 11 vs. 16 ± 3 mmHg; P < 0.0001), and there existed a wide variability of pulmonary artery pressure at high altitude with an estimated upper 95% limit of 52 mmHg. Moreover, pulmonary artery pressure and its altitude-induced increase were inversely related to age, resulting in an almost twofold larger increase in the 6- to 9- than in the 14- to 16-yr-old participants (24 ± 12 vs. 13 ± 8 mmHg; P = 0.004). Even in children with the most severe altitude-induced pulmonary hypertension, right ventricular systolic function did not decrease, but increased, and none of the children developed HAPE. HAPE appears to be a rare event in this young population after rapid ascent to this altitude at which major tourist destinations are located.

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Section: Discussionsupporting

confidence: 93%

Pulmonary artery pressure and cardiac function in children and adolescents after rapid ascent to 3,450 m

Allemann

Stüber

Marchi

et al. 2012

American Journal of Physiology-Heart and Circulatory Physiology

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“…However, these changes were generally very mild and noted mainly on pulsed wave mitral inflow only with a reduction in E velocity and an increase in A velocity and were not associated with an increase in estimated LV pressure or overt diastolic dysfunction. This led to the concept of compensated diastolic (dys)function in which minor alterations in mitral inflow as compensated for by enhanced atrial contraction (Alleman et al, 2004;Bernheim et al, 2007). This finding has been supported by the results of our present study.…”

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confidence: 88%

The Effects of Acute Hypobaric Hypoxia on Arterial Stiffness and Endothelial Function and its Relationship to Changes in Pulmonary Artery Pressure and Left Ventricular Diastolic Function

Boos

Hodkinson²,

Mellor

et al. 2012

High Altitude Medicine & Biology

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This study investigated, for the first time, the effects of simulated high altitude, following acute hypobaric hypoxia (HH), on simultaneous assessment of large artery stiffness and endothelial function and its inter-relationship to left ventricular (LV) diastolic function, pulmonary artery systolic pressure (PASP), and estimated PA vascular resistance (PVR). Ten healthy subjects were studied at baseline pre and following acute HH to 4800 m for a total of 180 minutes. Assessments of LV diastolic function, mitral inflow, estimated LV filling pressure (E/e'), PVR, and PASP were undertaken using transthoracic echocardiography. Simultaneous assessments of arterial stiffness index (SI), systemic vascular resistance (SVR), vascular tone, and endothelial function (reflective index [RI]) were performed using pulse contour analysis of the digital arterial waveform. Acute hypoxia led to a fall in SpO₂ (98.1±0.7 vs. 71.8±7.1%; p=0.0002), SVR (1589.1±191.2 vs. 1187.8±248.7; p=0.004), and RI (50.8±10.3 vs. 33.0±6.5%; p=0.0008) with an increase in PASP (24.3±2.2 to 35.0±5.3 mmHg; p=0.0001) and estimated PVR (116.40±19.0 vs. 144.6±21.5; p<0.001). There was no rise in either SI (p=0.13), mitral early annular early e' filling velocity or E/e'. There was a significant inverse correlation between SpO₂ and PASP (r=-0.77; p<0.0001), PVR (r=-0.57; p=0.008) and between the fall in SpO₂ and change (Δ) in RI (baseline vs. 150 min, r=-0.52; p<0.001). There was a modest inverse correlation between ΔRI (lower ΔRI=worsening endothelial function) and ΔPAP (r=-0.55; p=0.10) and a strong inverse correlation between ΔRI and ΔPVR (r=-0.89; p=0.0007). Acute hypobaric hypoxia does not significantly alter large artery stiffness or cause overt LV diastolic function. However, the degree of hypoxia influences both the systemic endothelial and pulmonary vascular responses. This noted association is intriguing and requires further investigation.

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“…Gibbs [37] postulated that impaired diastolic LV filling at altitude is a consequence of an RV pressure overload causing impaired RV function, a reduction of the stroke volume, and thus venous return to the LA. However, Bernheim et al [38] could not detect any correlation between LV diastolic dysfunction and acute changes in PAP due to exercise and exposure to high altitude in healthy subjects. It remains unclear if increases in PAP may be attributed to diastolic dysfunction or vice versa.…”

Section: Discussionmentioning

confidence: 91%

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

et al. 2018

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Background: Changes in pulmonary hemodynamics and cardiac function in patients with chronic obstructive pulmonary disease (COPD) traveling to altitude have not been assessed despite an increasing prevalence of the disease. Objectives: We hypothesized that pulmonary artery pressure (PAP) significantly increases and cardiac function deteriorates during exposure to hypobaric hypoxia as encountered by traveling to moderate altitude or air flight. Methods: A total of 37 patients (17 female; median age [quartiles] 66 years [60; 69] with COPD GOLD grade 2–3 [FEV₁ 57% predicted (49; 71)]) living < 800 m underwent echocardiography in Zurich (490 m) and after 1 night at Davos Jakobshorn (2,590 m) in a randomized order of allocation. Results: The transtricuspid pressure gradient increased from 23 mm Hg (18; 29) to 32 mm Hg (25; 41) (p < 0.0001; Δmedian [95% CI] 7.5 [2.0; 13.0]), the right ventricular fractional area change decreased from 45% (39; 49) to 38% (33; 43) (p = 0.002), while the heart rate and systolic blood pressure increased from 70 bpm (64; 78) to 82 bpm (70; 86) (p < 0.0001) and from 133 mm Hg (123; 141) to 136 mm Hg (126; 148) (p = 0.002), respectively, and left ventricular diastolic dysfunction was more prevalent (24–54%, p = 0.02). Conclusions: This is a first study assessing changes in pulmonary hemodynamics and cardiac function in patients with COPD during a short altitude sojourn. Despite the increase in PAP and indications of change in cardiac function, the exposure was well tolerated. None of the patients had to descend to lower altitude for symptomatic altitude-related disease.

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Acute Changes in Pulmonary Artery Pressures Due to Exercise and Exposure to High Altitude Do Not Cause Left Ventricular Diastolic Dysfunction

Cited by 33 publications

References 23 publications

Pulmonary artery pressure and cardiac function in children and adolescents after rapid ascent to 3,450 m

Pulmonary artery pressure and cardiac function in children and adolescents after rapid ascent to 3,450 m

The Effects of Acute Hypobaric Hypoxia on Arterial Stiffness and Endothelial Function and its Relationship to Changes in Pulmonary Artery Pressure and Left Ventricular Diastolic Function

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

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