Konstantinos Bitos, Julian Müller, Adilet Omuralieva, Simon R Schneider, Mona Lichtblau, Stéphanie Saxer, Felix C Tanner, Michael Furian, Maamed Mademilov, Talant Sooronbaev, Konrad E Bloch, Silvia Ulrich
{"title":"低海拔地区慢性阻塞性肺疾病患者在3100米高海拔地区3天的肺血流动力学超声心动图分析。","authors":"Konstantinos Bitos, Julian Müller, Adilet Omuralieva, Simon R Schneider, Mona Lichtblau, Stéphanie Saxer, Felix C Tanner, Michael Furian, Maamed Mademilov, Talant Sooronbaev, Konrad E Bloch, Silvia Ulrich","doi":"10.1093/ehjopen/oeaf017","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Patients with chronic obstructive pulmonary disease experience an increase in systolic pulmonary artery pressure (sPAP) when exposed to high altitude with an unclear acclimatization. We investigated the effects of acute ascent to 3100 m on pulmonary haemodynamics of patients with chronic obstructive pulmonary disease and their acclimatization during a 3-day stay at high altitude.</p><p><strong>Methods and results: </strong>In this prospective, interventional study, stable, normocapnic patients with chronic obstructive pulmonary disease, with FEV<sub>1</sub> 40-80%predicted and SpO<sub>2</sub> ≥ 92%, residing at low altitude and staying for 3 days/nights at 3100 m without adverse events, were included. Echocardiography was performed at 760 m, directly after arrival at 3100 m (HA1) and the two following days (HA2/HA3). The primary outcome was the change in sPAP at different time points. Additionally, cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE), and other echocardiographic parameters were measured. Thirty-eight patients with chronic obstructive pulmonary disease (37% females), aged (mean ± SD) 55 ± 10years, with FEV<sub>1</sub> 63 ± 12%predicted, were included. After acute ascent to 3100 m vs. 760 m, sPAP increased by 12 mmHg [95% confidence interval (CI): 9-15, <i>P</i> < 0.001], total pulmonary resistance (sPAP/CO) increased by 2 WU (1-3, <i>P</i> = 0.001), and TAPSE/sPAP decreased by -0.6 mm/mmHg (-0.9 to -0.2, <i>P</i> = 0.002). Right atrial pressure and CO were unchanged. At HA3 compared to HA1, sPAP decreased by -4 mmHg (-7 to -1, <i>P</i> = 0.008); no significant changes in further echocardiographic parameters were observed.</p><p><strong>Conclusion: </strong>In stable patients with chronic obstructive pulmonary disease travelling to and staying at 3100 m for 3 days/nights without adverse events, sPAP initially increased, along with an increased pulmonary resistance and a reduced right ventricular-arterial coupling reflected by a lower TAPSE/sPAP. Whereas sPAP steadily decreased during acclimatization, other echocardiographic parameters remained unchanged.</p>","PeriodicalId":93995,"journal":{"name":"European heart journal open","volume":"5 2","pages":"oeaf017"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935530/pdf/","citationCount":"0","resultStr":"{\"title\":\"Pulmonary haemodynamics by echocardiography over 3 days of acclimatization in lowlanders with chronic obstructive pulmonary disease travelling to 3100 m of high altitude.\",\"authors\":\"Konstantinos Bitos, Julian Müller, Adilet Omuralieva, Simon R Schneider, Mona Lichtblau, Stéphanie Saxer, Felix C Tanner, Michael Furian, Maamed Mademilov, Talant Sooronbaev, Konrad E Bloch, Silvia Ulrich\",\"doi\":\"10.1093/ehjopen/oeaf017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Patients with chronic obstructive pulmonary disease experience an increase in systolic pulmonary artery pressure (sPAP) when exposed to high altitude with an unclear acclimatization. We investigated the effects of acute ascent to 3100 m on pulmonary haemodynamics of patients with chronic obstructive pulmonary disease and their acclimatization during a 3-day stay at high altitude.</p><p><strong>Methods and results: </strong>In this prospective, interventional study, stable, normocapnic patients with chronic obstructive pulmonary disease, with FEV<sub>1</sub> 40-80%predicted and SpO<sub>2</sub> ≥ 92%, residing at low altitude and staying for 3 days/nights at 3100 m without adverse events, were included. Echocardiography was performed at 760 m, directly after arrival at 3100 m (HA1) and the two following days (HA2/HA3). The primary outcome was the change in sPAP at different time points. Additionally, cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE), and other echocardiographic parameters were measured. Thirty-eight patients with chronic obstructive pulmonary disease (37% females), aged (mean ± SD) 55 ± 10years, with FEV<sub>1</sub> 63 ± 12%predicted, were included. After acute ascent to 3100 m vs. 760 m, sPAP increased by 12 mmHg [95% confidence interval (CI): 9-15, <i>P</i> < 0.001], total pulmonary resistance (sPAP/CO) increased by 2 WU (1-3, <i>P</i> = 0.001), and TAPSE/sPAP decreased by -0.6 mm/mmHg (-0.9 to -0.2, <i>P</i> = 0.002). Right atrial pressure and CO were unchanged. At HA3 compared to HA1, sPAP decreased by -4 mmHg (-7 to -1, <i>P</i> = 0.008); no significant changes in further echocardiographic parameters were observed.</p><p><strong>Conclusion: </strong>In stable patients with chronic obstructive pulmonary disease travelling to and staying at 3100 m for 3 days/nights without adverse events, sPAP initially increased, along with an increased pulmonary resistance and a reduced right ventricular-arterial coupling reflected by a lower TAPSE/sPAP. Whereas sPAP steadily decreased during acclimatization, other echocardiographic parameters remained unchanged.</p>\",\"PeriodicalId\":93995,\"journal\":{\"name\":\"European heart journal open\",\"volume\":\"5 2\",\"pages\":\"oeaf017\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11935530/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European heart journal open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjopen/oeaf017\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European heart journal open","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ehjopen/oeaf017","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的：慢性阻塞性肺疾病患者暴露于高海拔环境时，其肺动脉收缩压（sPAP）升高且不适应环境。我们研究了急性上升到3100米对慢性阻塞性肺疾病患者肺血流动力学的影响以及他们在高海拔停留3天的适应情况。方法和结果：在这项前瞻性、介入性研究中，纳入了稳定的、正常有氧运动的慢性阻塞性肺疾病患者，FEV1预测40-80%，SpO2≥92%，居住在低海拔，在3100 m无不良事件居住3天/夜。超声心动图分别在760 m、3100 m到达后直接（HA1）和随后两天（HA2/HA3）进行。主要观察指标为不同时间点sPAP的变化。此外，测量心输出量（CO）、三尖瓣环平面收缩偏移（TAPSE）和其他超声心动图参数。纳入38例慢性阻塞性肺疾病患者（37%为女性），年龄（平均±SD） 55±10岁，预测FEV1为63±12%。急性上升到3100米和760米后，sPAP增加了12 mmHg[95%可信区间（CI）： 9-15, P < 0.001]，总肺阻力（sPAP/CO）增加了2 WU (1-3, P = 0.001)， TAPSE/sPAP下降了-0.6 mm/mmHg（-0.9至-0.2,P = 0.002）。右房压及CO无明显变化。与HA1相比，HA3时sPAP降低-4 mmHg (-7 ~ -1, P = 0.008)；其他超声心动图参数未见明显变化。结论：在前往3100米并在3100米处停留3天/夜无不良事件的稳定型慢性阻塞性肺疾病患者中，sPAP最初增加，同时肺阻力增加，右心室-动脉耦合降低，反映为较低的TAPSE/sPAP。而sPAP在适应过程中稳步下降，其他超声心动图参数保持不变。
Pulmonary haemodynamics by echocardiography over 3 days of acclimatization in lowlanders with chronic obstructive pulmonary disease travelling to 3100 m of high altitude.
Aims: Patients with chronic obstructive pulmonary disease experience an increase in systolic pulmonary artery pressure (sPAP) when exposed to high altitude with an unclear acclimatization. We investigated the effects of acute ascent to 3100 m on pulmonary haemodynamics of patients with chronic obstructive pulmonary disease and their acclimatization during a 3-day stay at high altitude.
Methods and results: In this prospective, interventional study, stable, normocapnic patients with chronic obstructive pulmonary disease, with FEV1 40-80%predicted and SpO2 ≥ 92%, residing at low altitude and staying for 3 days/nights at 3100 m without adverse events, were included. Echocardiography was performed at 760 m, directly after arrival at 3100 m (HA1) and the two following days (HA2/HA3). The primary outcome was the change in sPAP at different time points. Additionally, cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE), and other echocardiographic parameters were measured. Thirty-eight patients with chronic obstructive pulmonary disease (37% females), aged (mean ± SD) 55 ± 10years, with FEV1 63 ± 12%predicted, were included. After acute ascent to 3100 m vs. 760 m, sPAP increased by 12 mmHg [95% confidence interval (CI): 9-15, P < 0.001], total pulmonary resistance (sPAP/CO) increased by 2 WU (1-3, P = 0.001), and TAPSE/sPAP decreased by -0.6 mm/mmHg (-0.9 to -0.2, P = 0.002). Right atrial pressure and CO were unchanged. At HA3 compared to HA1, sPAP decreased by -4 mmHg (-7 to -1, P = 0.008); no significant changes in further echocardiographic parameters were observed.
Conclusion: In stable patients with chronic obstructive pulmonary disease travelling to and staying at 3100 m for 3 days/nights without adverse events, sPAP initially increased, along with an increased pulmonary resistance and a reduced right ventricular-arterial coupling reflected by a lower TAPSE/sPAP. Whereas sPAP steadily decreased during acclimatization, other echocardiographic parameters remained unchanged.
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