Pulmonary arterial pressure at rest and during exercise in chronic mountain sickness: a meta-analysis

Abstract

Up to 10% of the more than 140 million high-altitude dwellers worldwide suffer from chronic mountain sickness (CMS). Patients suffering from this debilitating problem often display increased pulmonary arterial pressure (PAP), which may contribute to exercise intolerance and right heart failure. However, there is little information on the usual PAP in these patients.We systematically reviewed and meta-analysed all data published in English or Spanish until June 2018 on echocardiographic estimations of PAP at rest and during mild exercise in CMS patients.Nine studies comprising 287 participants fulfilled the inclusion criteria. At rest, the point estimate from meta-analysis of the mean systolic PAP was 27.9 mmHg (95% CI 26.3–29.6 mmHg). These values are 11% (+2.7 mmHg) higher than those previously meta-analysed in apparently healthy high-altitude dwellers. During mild exercise (50 W) the difference in mean systolic PAP between patients and high-altitude dwellers was markedly more accentuated (48.3 versus 36.3 mmHg) than at rest.These findings indicate that in patients with CMS PAP is moderately increased at rest, but markedly increased during mild exercise, which will be common with activities of daily living.

Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders

“…In contrast to early studies, a recent meta-analysis revealed that resting PAP in patients with chronic mountain sickness is only slightly higher compared to apparently healthy high altitude dwellers [278]. Nevertheless, in chronic mountain sickness patients, PAP is significantly more accentuated during even mild exercise associated with daily activity [278,279].…”

“…Interestingly, calculations of PAP values in high altitude dwellers, taking into account the hematocrit, revealed that higher values in Andeans are due to higher hematocrit levels compared to Tibetans [277]. In contrast to early studies, a recent meta-analysis revealed that resting PAP in patients with chronic mountain sickness is only slightly higher compared to apparently healthy high altitude dwellers [278]. Nevertheless, in chronic mountain sickness patients, PAP is significantly more accentuated during even mild exercise associated with daily activity [278,279].…”

Long‐term chronic intermittent hypoxia: a particular form of chronic high‐altitude pulmonary hypertension

“…Soria et al. 22 concluded that HAPH is less common than previously expected at rest but frequent during daily activities. 22,23 However, according to Naeije, 23 this provocative finding must be reconciled with further analysis and validation.…”

“…12 Interestingly, two recent publications raised some doubts about the actual prevalence of a pathological mean systolic PAP for defining HAPH at rest in individuals with or without CMS; a systematic review performed by Soria et al 22 investigated mostly healthy male Andeans (Aymaras and Quechuas) who were high-altitude residents with CMS using mean systolic PAP, and posteriorly in the editorial by Naeije, 23 he recalculated the mPAP. Soria et al 22 concluded that HAPH is less common than previously expected at rest but frequent during daily activities. 22,23 However, according to Naeije, 23 this provocative finding must be reconciled with further analysis and validation.…”

“… 12 Interestingly, two recent publications raised some doubts about the actual prevalence of a pathological mean systolic PAP for defining HAPH at rest in individuals with or without CMS; a systematic review performed by Soria et al. 22 investigated mostly healthy male Andeans (Aymaras and Quechuas) who were high-altitude residents with CMS using mean systolic PAP, and posteriorly in the editorial by Naeije, 23 he recalculated the mPAP. Soria et al.…”