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Changes in cardiac function following a speed ascent to the top of Europe at 4808 m

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Abstract

Purpose

Both prolonged exercise and acute high-altitude exposure are known to induce cardiac changes. We sought to describe the cardiac responses to speed climbing at high-altitude, including left ventricular (LV) performance assessment using the myocardial work index (MWI), a new index derived from 2D speckle tracking echocardiography (STE).

Methods

Eleven elite alpinists (9 males, age: 26 ± 4 years) were evaluated before and immediately after a speed ascent of the Mont-Blanc (4808 m) by echocardiography using conventional measurements as well as STE and MWI computation with derivate parameters as global work efficiency (GWE) or global wasted work (GWW).

Results

Athletes performed a long-duration (8 h 58 min ± 60 min) and intense (78 ± 4% of maximal heart rate) ascent under gradual hypoxic conditions (minimal SpO2 at 4808 m: 71 ± 4%). Hypoxic exercise-induced cardiac fatigue was observed post-ascent with a change in right ventricular (RV) and LV systolic function (RV fractional area change: – 20 ± 23%, p = 0.01; LV global longitudinal strain change: – 8 ± 9%, p = 0.02), as well as LV geometry and RV–LV interaction alterations with emergence of a D-shape septum in 5/11 (46%) participants associated with RV pressure overload (mean pulmonary arterial pressure change: + 55 ± 20%, p < 0.001). Both MWI and GWE were reduced post-ascent (– 21 ± 16%, p = 0.004 and – 4 ± 4%, p = 0.007, respectively). Relative decrease in MWI and GWE were inversely correlated with increase in GWW (r = – 0.86, p = 0.003 and r = -0.97, p < 0.001, respectively).

Conclusions

Prolonged high-altitude speed climbing in elite climbers is associated with RV and LV function changes with a major interaction alteration. MWI, assessing the myocardial performance, could be a new tool for evaluating LV exercise-induced cardiac fatigue.

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Availability of data and materials

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Not applicable.

Abbreviations

ABP:

Arterial blood pressure

AMS:

Acute mountain sickness

ANOVA:

Analysis of variance

BM:

Body mass

GCW:

Global constructive work

GLS:

Global longitudinal strain

GWE:

Global work efficiency

GWW:

Global wasted work

[Hb]:

Hemoglobin concentration

Hct:

Hematocrit

HR:

Heart rate

HRmax :

Maximal heart rate

LV:

Left ventricle

LVED:

Left ventricle end-diastolic

LVEF:

Left ventricle ejection fraction

LVEI:

Left ventricle end-systolic eccentricity index

LLQ:

Lake Louise questionnaire

mPAP:

Mean pulmonary artery pressure

MWI:

Myocardial work index

PEH:

Postexercise hypotension

PV:

Plasma volume

RPE:

Rating of perceived exertion

RV:

Right ventricle

RV FAC:

Right ventricle fractional area change

SD:

Standard deviation

SV:

Stroke volume

sPAP:

Systolic pulmonary artery pressure

SpO2 :

Pulse oxygen saturation

STE:

Speckle tracking echocardiography

TTE:

Transthoracic echocardiography

\(\dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}}\) :

Peak oxygen uptake

References

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Acknowledgements

We thank the elite-climbers of the FFCAM and their supervisors for their enthusiastic participation, as well as the staff of the Goûter hut for technical assistance, Julia Roger-Veyer (RN) for expert technical assistance and the Centre national de la recherche scientifique (CNRS) délégation Alpes, for the provision of the Vallot Observatory. Two climbers from the Groupe Excellence National Alpinisme (GEAN), who participated in the study, accidentally passed away during the first ascent of the West face of the Mingbo Eiger (6070m) in Nepal, during collation of this manuscript. The authors express their sincere condolences to the climbers’ families and friends.

Funding

This study was supported by a grant from the FFCAM (Fédération Française des Clubs Alpins et de Montagne). However, the sponsor had no further involvement in any step of the project.

Author information

Author notes

  1. Benoit Champigneulle and Stéphane Doutreleau share first authorship.

  2. Pierre Bouzat and Samuel Verges share senior authorship.

Authors and Affiliations

  1. HP2 laboratory, UM Sports Pathologies, Hôpital Sud, Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, CS 10217, 38043 Cedex 9, Grenoble, France

    Benoit Champigneulle, Stéphane Doutreleau, Sébastien Baillieul, Julien Vincent Brugniaux, Paul Robach & Samuel Verges

  2. National School for Mountain Sports, Site of the National School for Skiing and Mountaineering (ENSA), Chamonix, France

    Paul Robach

  3. Univ. Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France

    Pierre Bouzat

Authors
  1. Benoit Champigneulle
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  2. Stéphane Doutreleau
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  3. Sébastien Baillieul
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  4. Julien Vincent Brugniaux
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  5. Paul Robach
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  6. Pierre Bouzat
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  7. Samuel Verges
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Contributions

BC, SD, SB, JVB, PR, PB and SV designed the study and acquired the data. BC and SD performed the statistical analysis. BC, SD, SB and SV analyzed and interpreted the data. BC, SD and SV wrote the manuscript; PB, PR, JVB and SB revised it critically for important intellectual content. All authors gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Benoit Champigneulle.

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Conflict of interest

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the French Ethics Committee CPP Ouest VI (approval reference number 2019-A01866-51).

Consent to participate

Written informed consent was obtained from all individual participants included in the study.

Consent to publication

The authors affirm that human research participants provided informed consent for publication.

Additional information

Communicated by Massimo Pagani.

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Cite this article

Champigneulle, B., Doutreleau, S., Baillieul, S. et al. Changes in cardiac function following a speed ascent to the top of Europe at 4808 m. Eur J Appl Physiol 122, 889–902 (2022). https://doi.org/10.1007/s00421-022-04895-6

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  • DOI: https://doi.org/10.1007/s00421-022-04895-6

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