Pulmonary pressure and cardiac function in chronic mountain sickness patients.
BACKGROUND
Chronic mountain sickness (CMS) is characterized by a loss of adaptation to hypoxia in high-altitude (HA) dwellers. Chronic hypoxemia, excessive erythrocytosis and frequently pulmonary hypertension (PH), which may lead to cardiac failure, develop in patients. We sought to assess the determinants of cardiac function in CMS patients with hypoxia-induced PH.


METHODS
Fifteen healthy men living at sea level (SL) were compared to 15 healthy men living at HA and 55 patients with CMS from Cerro de Pasco, Peru (altitude, 4,300 m). Pulmonary pressures and cardiac function were estimated by echocardiography.


RESULTS
None of the subjects had overt cardiac failure symptoms. CMS patients exhibited elevated mean pulmonary pressures as assessed by high-tricuspid pressure gradients (CMS patients, 34 +/- 10 mm Hg; HA subjects, 25 +/- 4 mm Hg [p = 0.002]; and SL subjects, 19 +/- 3 mm Hg [p < 0.001]). They also showed right ventricular (RV) dilation (mean end-diastolic RV area: CMS patients, 17 +/- 2 cm(2); HA subjects, 13 +/- 2 cm(2); SL subjects, 12 +/- 2 cm(2); p < 0.001) but did not display impaired systolic ventricular function. However, the RV Tei index was increased in CMS and HA subjects (CMS patients, 0.56 +/- 0.15; HA subjects, 0.52 +/- 0.12; SL subjects, 0.21 +/- 0.12; p < 0.001).


CONCLUSIONS
Despite obvious pulmonary arterial hypertension and right heart dilation, CMS patients did not show any symptom or echocardiographic parameter of heart failure.


BACKGROUND
ClinicalTrials.gov. Identifier: NCT00424970.
Maignan
Maxime
M
Université Paris 13, EA 2363 "Réponses Cellulaires et Fonctionnelles à l'hypoxie," Bobigny, France. Electronic address: maxime.maignan@free.fr.
Rivera-Ch
Maria
M
Facultad de Ciencias y Filosofia, Departamento de Ciencas Biologicas y Fisiologicas, Laboratorio de Fisiologia Comparada, Universidad Peruana Cayetano Heredia, Lima, Peru.
Privat
Catherine
C
Facultad de Ciencias y Filosofia, Departamento de Ciencas Biologicas y Fisiologicas, Laboratorio de Fisiologia Comparada, Universidad Peruana Cayetano Heredia, Lima, Peru.
Leòn-Velarde
Fabiola
F
Facultad de Ciencias y Filosofia, Departamento de Ciencas Biologicas y Fisiologicas, Laboratorio de Fisiologia Comparada, Universidad Peruana Cayetano Heredia, Lima, Peru.
Richalet
Jean-Paul
JP
Université Paris 13, EA 2363 "Réponses Cellulaires et Fonctionnelles à l'hypoxie," Bobigny, France.
Pham
Isabelle
I
Université Paris 13, EA 2363 "Réponses Cellulaires et Fonctionnelles à l'hypoxie," Bobigny, France.
D000064:Acclimatization / Q000502:physiology; D000328:Adult; D000532:Altitude Sickness / Q000175:diagnosis* / Q000453:epidemiology; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D004906:Erythrocyte Count; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006334:Heart Function Tests; D006339:Heart Rate; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D000860:Hypoxia / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009051:Mountaineering; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric