Pulmonary artery pressure in healthy subjects at 4250 m measured by Doppler echocardiography.
OBJECTIVE
Acute hypoxia causes vasoconstriction in the pulmonary arteries. This hypoxic pulmonary vasoconstriction (HPV) has been reported to be common in subjects exposed to high altitude. In the past, it has been difficult to directly measure this HPV because of the invasive nature of tests, but the recent availability of portable color flow Doppler ultrasound has enabled measurements of pulmonary artery systolic pressure (PASP) in the field. We set out to study the feasibility of this method to detect changes related to HPV at 4250 m. We hypothesized that significant changes in the cardiopulmonary circulation are seen at high altitude and are detectable with Doppler echocardiography. In addition, we hypothesized that detected changes are related to the syndrome of acute mountain sickness (AMS) and could be reversed using 100% oxygen.


METHODS
Over a 10-week period in the spring of 1998, 56 healthy lowlanders not normally residing at altitude were studied while visiting 4250 m in Nepal having walked from 2774 m. This was a cross-sectional observational study conducted by a single experienced observer at high altitude, using transthoracic color flow continuous wave Doppler echocardiography. Subjects were initially assessed for significant tricuspid regurgitation (TR) to measure PASP. After estimating PASP under ambient conditions at altitude, oxygen was delivered and PASP remeasured.


RESULTS
Of 56 subjects, 36 had Doppler signals appropriate for estimation of pulmonary artery systolic pressure. In these 36, a wide range of PASP was observed (mean 25 mm Hg, range 18-36 mm Hg), but none fell outside of the normal range. After oxygen administration, PASP was reduced (from mean 25 mm Hg to mean 18 mm Hg, P<.0001) suggesting that a degree of hypoxic pulmonary vasoconstriction was present. No subjects in the study group reported clinical AMS.


CONCLUSIONS
We found PASP at 4250 m to be within the normal range but higher than would be expected at sea level; however, unlike previous reports, we found such increases to be mild and reversible with oxygen. In addition, the observed incidence of AMS was low when compared with earlier studies, perhaps related to adequate acclimatization.
Dubowitz
Gerald
G
Department of Anesthesia, University of California, San Francisco, CA 94143-1605, USA. dubowitz@anesthesia.ucsf.edu
Peacock
Andrew J
AJ
D000531:Altitude; D000532:Altitude Sickness / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000000981:diagnostic imaging*; D008297:Male; D009051:Mountaineering; D011669:Pulmonary Wedge Pressure / Q000502:physiology*