Abstract
High altitude produces increased pulmonary capillary pressure by hypoxia induced pulmonary vasoconstriction. It is also possible that hypoxia results in mildly elevated left ventricular (LV) filling pressures that may contribute to the elevated capillary pressures. This study investigates the impact of simulated high altitude on global and regional echocardiographic measures of LV performance and filling pressure. Seventeen healthy individuals underwent transthoracic echocardiography, including tissue Doppler of the septal mitral annulus and basal segments before and after an 18-h overnight stay in a high altitude simulation tent with a FiO2 of 12%, simulating an altitude of approximately 4,000 m above sea level. In simulated high altitude, the ratio of early transmitral flow velocity to early myocardial relaxation velocity increased 22%, P < 0.001, and the Index of Myocardial Performance increased 30%, P < 0.01 due to an 58% increase in the isovolumic relaxation time (IVRT), P < 0.001. Simulated high altitude leads to a reduction in LV performance with an accompanying increase in markers of LV filling pressure. The significant changes in filling pattern and IVRT in the setting of normal and unchanged systolic function, indicates that hypoxia induces mild diastolic dysfunction in young healthy individuals.
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Allemann Y, Sartori C, Lepori M, Pierre S, Melot C, Naeije R, Scherrer U, Maggiorini M (2000) Echocardiographic and invasive measurements of pulmonary artery pressure correlate closely at high altitude. Am J Physiol Heart Circ Physiol 279:H2013–H2016
Allemann Y, Rotter M, Hutter D, Lipp E, Sartori C, Scherrer U, Seiler C (2004) Impact of acute hypoxic pulmonary hypertension on LV diastolic function in healthy mountaineers at high altitude. Am J Physiol Heart Circ Physiol 286:H856–H862
Balasubramanian V, Kaushik VS, Manchanda SC, Roy SB (1975) Effects of high altitude hypoxia on left ventricular systolic time intervals in man. Br Heart J 37:272–276
Bartsch P, Mairbaurl H, Maggiorini M, Swenson ER (2005) Physiological aspects of high-altitude pulmonary edema. J Appl Physiol 98:1101–1110
Busch T, Bartsch P, Pappert D, Grunig E, Hildebrandt W, Elser H, Falke KJ, Swenson ER (2001) Hypoxia decreases exhaled nitric oxide in mountaineers susceptible to high-altitude pulmonary edema. Am J Respir Crit Care Med 163:368–373
Fowles RE, Hultgren HN (1983) Left ventricular function at high altitude examined by systolic time intervals and M-mode echocardiography. Am J Cardiol 52:862–866
Garcia MJ, Ares MA, Asher C, Rodriguez L, Vandervoort P, Thomas JD (1997) An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure. J Am Coll Cardiol 29:448–454
Garcia MJ, Palac RT, Malenka DJ, Terrell P, Plehn JF (1999) Color M-mode Doppler flow propagation velocity is a relatively preload-independent index of left ventricular filling. J Am Soc Echocardiogr 12:129–137
Goetze JP, Gore A, Moller CH, Steinbruchel DA, Rehfeld JF, Nielsen LB (2004) Acute myocardial hypoxia increases BNP gene expression. FASEB J 18:1928–1930
Grunig E, Mereles D, Hildebrandt W, Swenson ER, Kubler W, Kuecherer H, Bartsch P (2000) Stress Doppler echocardiography for identification of susceptibility to high altitude pulmonary edema. J Am Coll Cardiol 35:980–987
Hirata K, Ban T, Jinnouchi Y, Kubo S (1991) Echocardiographic assessment of left ventricular function and wall motion at high altitude in normal subjects. Am J Cardiol 68:1692–1697
Huez S, Retailleau K, Unger P, Pavelescu A, Vachiery JL, Derumeaux G, Naeije R (2005) Right and left ventricular adaptation to hypoxia: a tissue Doppler imaging study. Am J Physiol Heart Circ Physiol 289:H1391–H1398
Kjaergaard J, Hassager C, Oh JK, Kristensen JH, Berning J, Sogaard P (2005) Measurement of cardiac time intervals by Doppler tissue m-mode imaging of the anterior mitral leaflet. J Am Soc Echocardiogr 18:1058–1065
Kjaergaard J, Snyder EM, Hassager C, Oh JK, Johnson BD (2006) Impact of preload and after-load on global and regional right ventricular function and pressure: A quantitative echocardiography study. J Am Soc Echocardiogr 19:515–521
Lisauskas JB, Singh J, Bowman AW, Kovacs SJ (2001) Chamber properties from transmitral flow: prediction of average and passive left ventricular diastolic stiffness. J Appl Physiol 91:154–162
Maggiorini M, Melot C, Pierre S, Pfeiffer F, Greve I, Sartori C, Lepori M, Hauser M, Scherrer U, Naeije R (2001) High-altitude pulmonary edema is initially caused by an increase in capillary pressure. Circulation 103:2078–2083
Nagaya N, Satoh T, Uematsu M, Okano Y, Kyotani S, Nakanishi N, Kunieda T (1997) Shortening of Doppler-derived deceleration time of early diastolic transmitral flow in the presence of pulmonary hypertension through ventricular interaction. Am J Cardiol 79:1502–1506
Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533
Oh JK, Tajik J (2003) The return of cardiac time intervals: the phoenix is rising. J Am Coll Cardiol 42:1471–1474
Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794
Perhonen M, Takala TE, Vuolteenaho O, Mantymaa P, Leppaluoto J, Ruskoaho H (1997) Induction of cardiac natriuretic peptide gene expression in rats trained in hypobaric hypoxic conditions. Am J Physiol 273:R344–R352
Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA (2002) Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. J Am Soc Echocardiogr 15:167–184
Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289:194–202
Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA (2005) Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation 112:2254–2262
Ricart A, Maristany J, Fort N, Leal C, Pages T, Viscor G (2005) Effects of sildenafil on the human response to acute hypoxia and exercise. High Alt Med Biol 6:43–49
Sartori C, Allemann Y, Trueb L, Lepori M, Maggiorini M, Nicod P, Scherrer U (2000) Exaggerated pulmonary hypertension is not sufficient to trigger high-altitude pulmonary oedema in humans. Schweiz Med Wochenschr 130:385–389
Sartori C, Allemann Y, Duplain H, Lepori M, Egli M, Lipp E, Hutter D, Turini P, Hugli O, Cook S, Nicod P, Scherrer U (2002) Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med 346:1631–1636
Savourey G, Guinet A, Besnard Y, Garcia N, Hanniquet AM, Bittel J (1995) Evaluation of the Lake Louise acute mountain sickness scoring system in a hypobaric chamber. Aviat Space Environ Med 66:963–967
Scherrer U, Sartori C, Lepori M, Allemann Y, Duplain H, Trueb L, Nicod P (1999) High-altitude pulmonary edema: from exaggerated pulmonary hypertension to a defect in transepithelial sodium transport. Adv Exp Med Biol 474:93–107
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2:358–367
Shave RE, Dawson E, Whyte G, George K, Gaze D, Collinson P (2004) Effect of prolonged exercise in a hypoxic environment on cardiac function and cardiac troponin T. Br J Sports Med 38:86–88
Stojnic BB, Brecker SJ, Xiao HB, Helmy SM, Mbaissouroum M, Gibson DG (1992) Left ventricular filling characteristics in pulmonary hypertension: a new mode of ventricular interaction. Br Heart J 68:16–20
Sun JP, Popovic ZB, Greenberg NL, Xu XF, Asher CR, Stewart WJ, Thomas JD (2004) Noninvasive quantification of regional myocardial function using Doppler-derived velocity, displacement, strain rate, and strain in healthy volunteers: effects of aging. J Am Soc Echocardiogr 17:132–138
Sutherland GR, Di Salvo G, Claus P, D’hooge J, Bijnens B (2004) Strain and strain rate imaging: a new clinical approach to quantifying regional myocardial function. J Am Soc Echocardiogr 17:788–802
Swenson ER, Maggiorini M, Mongovin S, Gibbs JS, Greve I, Mairbaurl H, Bartsch P (2002) Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic factor. JAMA 287:2228–2235
Tei C, Nishimura RA, Seward JB, Tajik AJ (1997) Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr 10:169–178
Toth M, Vuorinen KH, Vuolteenaho O, Hassinen IE, Uusimaa PA, Leppaluoto J, Ruskoaho H (1994) Hypoxia stimulates release of ANP and BNP from perfused rat ventricular myocardium. Am J Physiol 266:H1572–H1580
Vogel M, Cheung MM, Li J, Kristiansen SB, Schmidt MR, White PA, Sorensen K, Redington AN (2003) Noninvasive assessment of left ventricular force-frequency relationships using tissue Doppler-derived isovolumic acceleration: validation in an animal model. Circulation 107:1647–1652
Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT (2005) Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 294:1944–1956
Acknowledgments
Study coordinators Minelle Hulsebus and Kathy O’Malley are thanked for their devoted work to the recruitment and data collection, and sonographer Jo-Ellen Ehrsam RDCS is acknowledged for her efforts in acquiring the echocardiographic images. This work was supported by NIH grant HL71478, AHA grants 56051Z, and 0525727Z and by US Public Health Service grant M01-RR00585. The Danish Heart Foundation supported the research fellowship of Dr. Kjaergaard, grant no. 04-10-B109-A166-22192.
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Kjaergaard, J., Snyder, E.M., Hassager, C. et al. The effect of 18 h of simulated high altitude on left ventricular function. Eur J Appl Physiol 98, 411–418 (2006). https://doi.org/10.1007/s00421-006-0299-1
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DOI: https://doi.org/10.1007/s00421-006-0299-1