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首页> 外文期刊>American Journal of Physiology >Impact of acute hypoxic pulmonary hypertension on LV diastolic function in healthy mountaineers at high altitude.
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Impact of acute hypoxic pulmonary hypertension on LV diastolic function in healthy mountaineers at high altitude.

机译：急性低氧性肺动脉高压对健康高海拔登山者左室舒张功能的影响。

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In pulmonary hypertension right ventricular pressure overload leads to abnormal left ventricular (LV) diastolic function. Acute high-altitude exposure is associated with hypoxia-induced elevation of pulmonary artery pressure particularly in the setting of high-altitude pulmonary edema. Tissue Doppler imaging (TDI) allows assessment of LV diastolic function by direct measurements of myocardial velocities independently of cardiac preload. We hypothesized that in healthy mountaineers, hypoxia-induced pulmonary artery hypertension at high altitude is quantitatively related to LV diastolic function as assessed by conventional and TDI Doppler methods. Forty-one healthy subjects (30 men and 11 women; mean age 41 +/- 12 yr) underwent transthoracic echocardiography at low altitude (550 m) and after a rapid ascent to high altitude (4,559 m). Measurements included the right ventricular to right atrial pressure gradient (DeltaP(RV-RA)), transmitral early (E) and late (A) diastolic flow velocities and mitral annular early (E(m)) and late (A(m)) diastolic velocities obtained by TDI at four locations: septal, inferior, lateral, and anterior. At a high altitude, DeltaP(RV-RA) increased from 16 +/- 7 to 44 +/- 15 mmHg (P < 0.0001), whereas the transmitral E-to-A ratio (E/A ratio) was significantly lower (1.11 +/- 0.27 vs. 1.41 +/- 0.35; P < 0.0001) due to a significant increase of A from 52 +/- 15 to 65 +/- 16 cm/s (P = 0.0001). DeltaP(RV-RA) and transmitral E/A ratio were inversely correlated (r(2) = 0.16; P = 0.0002) for the whole spectrum of measured values (low and high altitude). Diastolic mitral annular motion interrogation showed similar findings for spatially averaged (four locations) as well as for the inferior and septal locations: A(m) increased from low to high altitude (all P < 0.01); consequently, E(m)/A(m) ratio was lower at high versus low altitude (all P < 0.01). These intraindividual changes were reflected interindividually by an inverse correlation between DeltaP(RV-RA) and E(m)/A(m) (all P < 0.006) and a positive association between DeltaP(RV-RA) and A(m) (all P < 0.0009). In conclusion, high-altitude exposure led to a two- to threefold increase in pulmonary artery pressure in healthy mountaineers. This acute increase in pulmonary artery pressure led to a change in LV diastolic function that was directly correlated with the severity of pulmonary hypertension. However, in contrast to patients suffering from some form of cardiopulmonary disease and pulmonary hypertension, in these healthy subjects, overt LV diastolic dysfunction was not observed because it was prevented by augmented atrial contraction. We propose the new concept of compensated diastolic (dys)function.
机译：在肺动脉高压中，右心室压力超负荷会导致左心室（LV）舒张功能异常。急性高海拔暴露与低氧引起的肺动脉压升高有关，尤其是在高海拔肺水肿的情况下。组织多普勒成像（TDI）可通过独立于心脏预负荷的直接测量心肌速度来评估LV舒张功能。我们假设，在健康的登山者中，通过常规和TDI多普勒方法评估，高海拔地区低氧引起的肺动脉高压与LV舒张功能定量相关。 41名健康受试者（30名男性和11名女性;平均年龄41 +/- 12岁）在低海拔（550 m）以及急速上升到高海拔（4,559 m）后接受了经胸超声心动图检查。测量包括右心室到右心房压力梯度（DeltaP（RV-RA）），穿刺早期（E）和晚期（A）舒张血流速度以及二尖瓣环早期（E（m））和晚期（A（m））通过TDI在四个位置获得的舒张速度：中隔，下，外侧和前部。在高海拔地区，DeltaP（RV-RA）从16 +/- 7 mmHg增加到44 +/- 15 mmHg（P <0.0001），而透射E / A比（E / A比）明显更低（ 1.11 +/- 0.27 vs.1.41 +/- 0.35; P <0.0001），这是由于A从52 +/- 15 cm / s显着增加到65 +/- 16 cm / s（P = 0.0001）。 DeltaP（RV-RA）与透射E / A比值在整个测量值范围（低海拔和高海拔）中呈负相关（r（2）= 0.16; P = 0.0002）。对于空间平均（四个位置）以及下，中隔位置，舒张二尖瓣环运动询问显示出相似的发现：A（m）从低海拔增加到高海拔（所有P <0.01）;因此，高海拔与低海拔的E（m）/ A（m）之比较低（所有P <0.01）。这些个体内的变化通过DeltaP（RV-RA）与E（m）/ A（m）之间的负相关关系相互反映（所有P <0.006）以及DeltaP（RV-RA）与A（m）之间的正相关关系（所有P <0.0009）。总之，高海拔暴露会使健康登山者的肺动脉压力增加2到3倍。肺动脉压的这种急剧增加导致左室舒张功能的改变，这与肺动脉高压的严重程度直接相关。但是，与患有某种形式的心肺疾病和肺动脉高压的患者相反，在这些健康受试者中，未观察到明显的LV舒张功能障碍，因为它可以通过增加心房收缩来预防。我们提出了补偿舒张功能障碍的新概念。

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