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RV contractility and exercise-induced pulmonary hypertension in chronic mountain sickness: a stress echocardiographic and tissue Doppler imaging study.
JACC Cardiovasc Imaging. 2013 Dec; 6(12):1287-97.JC

Abstract

OBJECTIVES

The aim of this study was to evaluate right ventricular (RV) and left ventricular function and pulmonary circulation in chronic mountain sickness (CMS) patients with rest and stress echocardiography compared with healthy high-altitude (HA) dwellers.

BACKGROUND

CMS or Monge's disease is defined by excessive erythrocytosis (hemoglobin >21 g/dl in males, 19 g/dl in females) and severe hypoxemia. In some cases, a moderate or severe increase in pulmonary pressure is present, suggesting a similar pathogenesis of pulmonary hypertension.

METHODS

In La Paz (Bolivia, 3,600 m sea level), 46 CMS patients and 40 HA dwellers of similar age were evaluated at rest and during semisupine bicycle exercise. Pulmonary artery pressure (PAP), pulmonary vascular resistance, and cardiac function were estimated by Doppler echocardiography.

RESULTS

Compared with HA dwellers, CMS patients showed RV dilation at rest (RV mid diameter: 36 ± 5 mm vs. 32 ± 4 mm, CMS vs. HA, p = 0.001) and reduced RV fractional area change both at rest (35 ± 9% vs. 43 ± 9%, p = 0.002) and during exercise (36 ± 9% vs. 43 ± 8%, CMS vs. HA, p = 0.005). The RV systolic longitudinal function (RV-S') decreased in CMS patients, whereas it increased in the control patients (p < 0.0001) at peak stress. The RV end-systolic pressure-area relationship, a load independent surrogate of RV contractility, was similar in CMS patients and HA dwellers with a significant increase in systolic PAP and pulmonary vascular resistance in CMS patients (systolic PAP: 50 ± 12 mm Hg vs. 38 ± 8 mm Hg, CMS vs. HA, p < 0.0001; pulmonary vascular resistance: 2.9 ± 1 mm Hg/min/l vs. 2.2 ± 1 mm Hg/min/l, p = 0.03). Both groups showed comparable systolic and diastolic left ventricular function both at rest and during stress.

CONCLUSIONS

Comparable RV contractile reserve in CMS and HA suggests that the lower resting values of RV function in CMS may represent a physiological adaptation to chronic hypoxic conditions rather than impaired RV function. (Chronic Mountain Sickness, Systemic Vascular Function [CMS]; NCT01182792).

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    Authors+Show Affiliations

    Pratali L
    Institute of Clinical Physiology, CNR, Pisa, Italy. Electronic address: lorenza@ifc.cnr.it.
    Allemann Y
    University Hospital of Bern, Cardiology, Bern, Switzerland.
    Rimoldi SF
    University Hospital of Bern, Cardiology, Bern, Switzerland.
    Faita F
    Institute of Clinical Physiology, CNR, Pisa, Italy.
    Hutter D
    University Hospital of Bern, Cardiology, Bern, Switzerland.
    Rexhaj E
    University Hospital of Bern, Cardiology, Bern, Switzerland.
    Brenner R
    Division of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
    Bailey DM
    Neurovascular Research Laboratory, Faculty of Health, Science and Sport, University of Glamorgan, Pontypridd, United Kingdom.
    Sartori C
    Department of Internal Medicine and Botnar Center for Clinical Research, Lausanne, Switzerland.
    Salmon CS
    Instituto Boliviano de Biologia de Altura, La Paz, Bolivia.
    Villena M
    Instituto Boliviano de Biologia de Altura, La Paz, Bolivia.
    Scherrer U
    University Hospital of Bern, Cardiology, Bern, Switzerland; Facultad de Ciencias, Departamento de Biología, Universidad de Tarapacá, Arica, Chile.
    Picano E
    Institute of Clinical Physiology, CNR, Pisa, Italy.
    Sicari R
    Institute of Clinical Physiology, CNR, Pisa, Italy.

    MeSH

    AcclimatizationAdultAltitudeAltitude SicknessArterial PressureBoliviaChronic DiseaseEchocardiography, DopplerEchocardiography, StressExerciseExercise TestHumansHypertension, PulmonaryMaleMiddle AgedMyocardial ContractionPredictive Value of TestsPulmonary CirculationSwitzerlandVascular ResistanceVentricular Function, LeftVentricular Function, Right

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    24269266

    Clinical Trial Links

    Clinical trial which this article describes

    Citation

    Pratali, Lorenza, et al. "RV Contractility and Exercise-induced Pulmonary Hypertension in Chronic Mountain Sickness: a Stress Echocardiographic and Tissue Doppler Imaging Study." JACC. Cardiovascular Imaging, vol. 6, no. 12, 2013, pp. 1287-97.
    Pratali L, Allemann Y, Rimoldi SF, et al. RV contractility and exercise-induced pulmonary hypertension in chronic mountain sickness: a stress echocardiographic and tissue Doppler imaging study. JACC Cardiovasc Imaging. 2013;6(12):1287-97.
    Pratali, L., Allemann, Y., Rimoldi, S. F., Faita, F., Hutter, D., Rexhaj, E., Brenner, R., Bailey, D. M., Sartori, C., Salmon, C. S., Villena, M., Scherrer, U., Picano, E., & Sicari, R. (2013). RV contractility and exercise-induced pulmonary hypertension in chronic mountain sickness: a stress echocardiographic and tissue Doppler imaging study. JACC. Cardiovascular Imaging, 6(12), 1287-97. https://doi.org/10.1016/j.jcmg.2013.08.007
    Pratali L, et al. RV Contractility and Exercise-induced Pulmonary Hypertension in Chronic Mountain Sickness: a Stress Echocardiographic and Tissue Doppler Imaging Study. JACC Cardiovasc Imaging. 2013;6(12):1287-97. PubMed PMID: 24269266.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - RV contractility and exercise-induced pulmonary hypertension in chronic mountain sickness: a stress echocardiographic and tissue Doppler imaging study. AU - Pratali,Lorenza, AU - Allemann,Yves, AU - Rimoldi,Stefano F, AU - Faita,Francesco, AU - Hutter,Damian, AU - Rexhaj,Emrush, AU - Brenner,Roman, AU - Bailey,Damian M, AU - Sartori,Claudio, AU - Salmon,Carlos Salinas, AU - Villena,Mercedes, AU - Scherrer,Urs, AU - Picano,Eugenio, AU - Sicari,Rosa, Y1 - 2013/10/23/ PY - 2013/05/17/received PY - 2013/08/02/revised PY - 2013/08/09/accepted PY - 2013/11/26/entrez PY - 2013/11/26/pubmed PY - 2014/8/12/medline KW - CMS KW - E KW - E/e′ KW - HA KW - Hb KW - LV KW - PAP KW - RV KW - RV-ESPAR KW - RV-S′ KW - TDI KW - chronic mountain sickness KW - exercise echocardiography KW - e′ KW - hemoglobin KW - high altitude KW - left ventricular KW - peak early diastolic tissue Doppler imaging velocity of the mitral annulus KW - peak velocity of early mitral inflow KW - pulmonary arterial pressure KW - ratio of early (e′) and late (a′) diastolic tissue Doppler imaging tricuspid peak annular velocities KW - ratio of peak velocity of early mitral inflow to mitral annular early diastolic peak velocity KW - right ventricular KW - right ventricular end-systolic pressure-area relationship KW - right ventricular function KW - systolic pulmonary hypertension KW - tissue Doppler imaging KW - tissue Doppler imaging peak systolic velocity of the lateral tricuspid valve annulus KW - tric e′/a′ SP - 1287 EP - 97 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 6 IS - 12 N2 - OBJECTIVES: The aim of this study was to evaluate right ventricular (RV) and left ventricular function and pulmonary circulation in chronic mountain sickness (CMS) patients with rest and stress echocardiography compared with healthy high-altitude (HA) dwellers. BACKGROUND: CMS or Monge's disease is defined by excessive erythrocytosis (hemoglobin >21 g/dl in males, 19 g/dl in females) and severe hypoxemia. In some cases, a moderate or severe increase in pulmonary pressure is present, suggesting a similar pathogenesis of pulmonary hypertension. METHODS: In La Paz (Bolivia, 3,600 m sea level), 46 CMS patients and 40 HA dwellers of similar age were evaluated at rest and during semisupine bicycle exercise. Pulmonary artery pressure (PAP), pulmonary vascular resistance, and cardiac function were estimated by Doppler echocardiography. RESULTS: Compared with HA dwellers, CMS patients showed RV dilation at rest (RV mid diameter: 36 ± 5 mm vs. 32 ± 4 mm, CMS vs. HA, p = 0.001) and reduced RV fractional area change both at rest (35 ± 9% vs. 43 ± 9%, p = 0.002) and during exercise (36 ± 9% vs. 43 ± 8%, CMS vs. HA, p = 0.005). The RV systolic longitudinal function (RV-S') decreased in CMS patients, whereas it increased in the control patients (p < 0.0001) at peak stress. The RV end-systolic pressure-area relationship, a load independent surrogate of RV contractility, was similar in CMS patients and HA dwellers with a significant increase in systolic PAP and pulmonary vascular resistance in CMS patients (systolic PAP: 50 ± 12 mm Hg vs. 38 ± 8 mm Hg, CMS vs. HA, p < 0.0001; pulmonary vascular resistance: 2.9 ± 1 mm Hg/min/l vs. 2.2 ± 1 mm Hg/min/l, p = 0.03). Both groups showed comparable systolic and diastolic left ventricular function both at rest and during stress. CONCLUSIONS: Comparable RV contractile reserve in CMS and HA suggests that the lower resting values of RV function in CMS may represent a physiological adaptation to chronic hypoxic conditions rather than impaired RV function. (Chronic Mountain Sickness, Systemic Vascular Function [CMS]; NCT01182792). SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/24269266/RV_contractility_and_exercise_induced_pulmonary_hypertension_in_chronic_mountain_sickness:_a_stress_echocardiographic_and_tissue_Doppler_imaging_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(13)00664-5 DB - PRIME DP - Unbound Medicine ER -