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Evidence supportive of impaired myocardial blood flow reserve at high altitude in subjects developing high-altitude pulmonary edema.
Am J Physiol Heart Circ Physiol. 2008 Apr; 294(4):H1651-7.AJ

Abstract

An exaggerated increase in pulmonary arterial pressure is the hallmark of high-altitude pulmonary edema (HAPE) and is associated with endothelial dysfunction of the pulmonary vasculature. Whether the myocardial circulation is affected as well is not known. The aim of this study was, therefore, to investigate whether myocardial blood flow reserve (MBFr) is altered in mountaineers developing HAPE. Healthy mountaineers taking part in a trial of prophylactic treatment of HAPE were examined at low (490 m) and high altitude (4,559 m). MBFr was derived from low mechanical index contrast echocardiography, performed at rest and during submaximal exercise. Among 24 subjects evaluated for MBFr, 9 were HAPE-susceptible individuals on prophylactic treatment with dexamethasone or tadalafil, 6 were HAPE-susceptible individuals on placebo, and 9 persons without HAPE susceptibility served as controls. At low altitude, MBFr did not differ between groups. At high altitude, MBFr increased significantly in HAPE-susceptible individuals on treatment (from 2.2 +/- 0.8 at low to 2.9 +/- 1.0 at high altitude, P = 0.04) and in control persons (from 1.9 +/- 0.8 to 2.8 +/- 1.0, P = 0.02), but not in HAPE-susceptible individuals on placebo (2.5 +/- 0.3 and 2.0 +/- 1.3 at low and high altitude, respectively, P > 0.1). The response to high altitude was significantly different between the two groups (P = 0.01). There was a significant inverse relation between the increase in the pressure gradient across the tricuspid valve and the change in myocardial blood flow reserve. HAPE-susceptible individuals not taking prophylactic treatment exhibit a reduced MBFr compared with either treated HAPE-susceptible individuals or healthy controls at high altitude.

Authors+Show Affiliations

Dept. of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Controlled Clinical Trial
Journal Article

Language

eng

PubMed ID

18310524

Citation

Kaufmann, B A., et al. "Evidence Supportive of Impaired Myocardial Blood Flow Reserve at High Altitude in Subjects Developing High-altitude Pulmonary Edema." American Journal of Physiology. Heart and Circulatory Physiology, vol. 294, no. 4, 2008, pp. H1651-7.
Kaufmann BA, Bernheim AM, Kiencke S, et al. Evidence supportive of impaired myocardial blood flow reserve at high altitude in subjects developing high-altitude pulmonary edema. Am J Physiol Heart Circ Physiol. 2008;294(4):H1651-7.
Kaufmann, B. A., Bernheim, A. M., Kiencke, S., Fischler, M., Sklenar, J., Mairbäurl, H., Maggiorini, M., & Brunner-La Rocca, H. P. (2008). Evidence supportive of impaired myocardial blood flow reserve at high altitude in subjects developing high-altitude pulmonary edema. American Journal of Physiology. Heart and Circulatory Physiology, 294(4), H1651-7. https://doi.org/10.1152/ajpheart.00760.2007
Kaufmann BA, et al. Evidence Supportive of Impaired Myocardial Blood Flow Reserve at High Altitude in Subjects Developing High-altitude Pulmonary Edema. Am J Physiol Heart Circ Physiol. 2008;294(4):H1651-7. PubMed PMID: 18310524.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence supportive of impaired myocardial blood flow reserve at high altitude in subjects developing high-altitude pulmonary edema. AU - Kaufmann,B A, AU - Bernheim,A M, AU - Kiencke,S, AU - Fischler,M, AU - Sklenar,J, AU - Mairbäurl,H, AU - Maggiorini,M, AU - Brunner-La Rocca,H P, Y1 - 2008/02/29/ PY - 2008/3/4/pubmed PY - 2008/5/30/medline PY - 2008/3/4/entrez SP - H1651 EP - 7 JF - American journal of physiology. Heart and circulatory physiology JO - Am. J. Physiol. Heart Circ. Physiol. VL - 294 IS - 4 N2 - An exaggerated increase in pulmonary arterial pressure is the hallmark of high-altitude pulmonary edema (HAPE) and is associated with endothelial dysfunction of the pulmonary vasculature. Whether the myocardial circulation is affected as well is not known. The aim of this study was, therefore, to investigate whether myocardial blood flow reserve (MBFr) is altered in mountaineers developing HAPE. Healthy mountaineers taking part in a trial of prophylactic treatment of HAPE were examined at low (490 m) and high altitude (4,559 m). MBFr was derived from low mechanical index contrast echocardiography, performed at rest and during submaximal exercise. Among 24 subjects evaluated for MBFr, 9 were HAPE-susceptible individuals on prophylactic treatment with dexamethasone or tadalafil, 6 were HAPE-susceptible individuals on placebo, and 9 persons without HAPE susceptibility served as controls. At low altitude, MBFr did not differ between groups. At high altitude, MBFr increased significantly in HAPE-susceptible individuals on treatment (from 2.2 +/- 0.8 at low to 2.9 +/- 1.0 at high altitude, P = 0.04) and in control persons (from 1.9 +/- 0.8 to 2.8 +/- 1.0, P = 0.02), but not in HAPE-susceptible individuals on placebo (2.5 +/- 0.3 and 2.0 +/- 1.3 at low and high altitude, respectively, P > 0.1). The response to high altitude was significantly different between the two groups (P = 0.01). There was a significant inverse relation between the increase in the pressure gradient across the tricuspid valve and the change in myocardial blood flow reserve. HAPE-susceptible individuals not taking prophylactic treatment exhibit a reduced MBFr compared with either treated HAPE-susceptible individuals or healthy controls at high altitude. SN - 0363-6135 UR - https://www.unboundmedicine.com/medline/citation/18310524/Evidence_supportive_of_impaired_myocardial_blood_flow_reserve_at_high_altitude_in_subjects_developing_high_altitude_pulmonary_edema_ L2 - http://www.physiology.org/doi/full/10.1152/ajpheart.00760.2007?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -