Right Ventricular Morphology and Function in Chronic Obstructive Pulmonary Disease Patients Living at High Altitude

Güvenç, Tolga Sinan; Erer, Hatice Betül; Kul, Şeref; Perinçek, Gökhan; İlhan, Sami; Sayar, Nurten; Yıldırım, Binnaz Zeynep; Doğan, Coşkun; Karabağ, Yavuz; Balcı, Bahattin; Eren, Mehmet

doi:10.1016/j.hlc.2012.08.004

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…These results are in accordance with data published by Güvenç et al [31] describing larger enddiastolic and end-systolic RV diameters and end-systolic areas as well as reduced FAC in patients with COPD liv- ing at moderate altitude. As in our study collective, Gü-venç et al [31] could not detect any difference in TAPSE when comparing patients with COPD living at sea level with those living at moderate altitude, which might indicate that impairments of RV function are only mild, mainly driven by an increased volume and an only minor reduction in contractility.…”

Section: Discussionsupporting

confidence: 93%

“…It remains unclear if increases in PAP may be attributed to diastolic dysfunction or vice versa. The previously mentioned study by Güvenç et al [31] found no significant difference in mitral E or A wave between patients with COPD living at sea level and those living at moderate altitude (1,768 m). A partial influence of impaired LV diastolic function on increases in PAP cannot be completely dismissed, even though an association was not found in our regression analysis.…”

Section: Discussionmentioning

confidence: 78%

“…Whether the increase in PAP and the deterioration in RV function in lowlanders with COPD is sustained during prolonged exposure to altitude and associated with clinically relevant altitude-related adverse health effects, or whether acclimatization will improve the acute deterioration, is not known. Güvenç et al [31] have shown a significantly higher PAP in high-altitude residents with COPD, and additionally it has been shown that COPD is associated with higher mortality among inhabitants of higher altitudes compared to lowlanders; however, the underlying mechanism is not yet understood [5,6]. It might be postulated that the impairment of pulmonary vascular and RV function is one possible explanation.…”

Section: Discussionmentioning

confidence: 99%

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Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

et al. 2018

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Background: Changes in pulmonary hemodynamics and cardiac function in patients with chronic obstructive pulmonary disease (COPD) traveling to altitude have not been assessed despite an increasing prevalence of the disease. Objectives: We hypothesized that pulmonary artery pressure (PAP) significantly increases and cardiac function deteriorates during exposure to hypobaric hypoxia as encountered by traveling to moderate altitude or air flight. Methods: A total of 37 patients (17 female; median age [quartiles] 66 years [60; 69] with COPD GOLD grade 2–3 [FEV₁ 57% predicted (49; 71)]) living < 800 m underwent echocardiography in Zurich (490 m) and after 1 night at Davos Jakobshorn (2,590 m) in a randomized order of allocation. Results: The transtricuspid pressure gradient increased from 23 mm Hg (18; 29) to 32 mm Hg (25; 41) (p < 0.0001; Δmedian [95% CI] 7.5 [2.0; 13.0]), the right ventricular fractional area change decreased from 45% (39; 49) to 38% (33; 43) (p = 0.002), while the heart rate and systolic blood pressure increased from 70 bpm (64; 78) to 82 bpm (70; 86) (p < 0.0001) and from 133 mm Hg (123; 141) to 136 mm Hg (126; 148) (p = 0.002), respectively, and left ventricular diastolic dysfunction was more prevalent (24–54%, p = 0.02). Conclusions: This is a first study assessing changes in pulmonary hemodynamics and cardiac function in patients with COPD during a short altitude sojourn. Despite the increase in PAP and indications of change in cardiac function, the exposure was well tolerated. None of the patients had to descend to lower altitude for symptomatic altitude-related disease.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

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Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

et al. 2018

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“…Despite this increase, systolic and diastolic functions of the RV, as well as global RV performance were similar in COPD patients living at high altitude and sea level, suggesting an adaptation to chronic hypoxia in those patients [ 23 ].…”

Section: Patients With Pre-existing Diseases: Copd Myocardial Infarcmentioning

confidence: 88%

Right Ventricle and High Altitude

Richalet

Pichon

2014

The Right Heart

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At high altitude, as hypoxia induces pulmonary vasoconstriction and increases ipulmonary arterial pressure, right ventricular (RV) function will be affected. The right ventricular function may be affected directly by the hypoxaemic challenge or indirectly through a pressure overload due, in turn to changes in the pulmonary circulation. Both animal and human studies show that moderate or transient hypoxia results in adaptive changes in right ventricle that are reversible with re-exposure to normoxic conditions and RV dysfunction is mainly due to mechanical overload from the pulmonary circulation. When hypoxia is more severe or more prolonged, it may directly impact ventricular diastolic or systolic function through mechanisms that remain to be unraveled. Chronic exposure to hypoxia in high-altitude natives suffering from Monge's disease may lead to RV hypertrophy, RV failure and overall cardiac failure. The adrenergic system may be involved, as well as HIF, PKC or phospholamban. More studies using the latest imaging technology should give us a better understanding of RV systolic and diastolic function in humans exposed to altitude hypoxia including acute, chronic or chronic intermittent hypoxia.

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“…Although limited field studies have been performed, one study in 1978 showed that resting PaO2 dropped to just 51.2mmHg within 3hrs of arriving at 1920m altitude, and PaO2 universally dropped below 6.7 during light exercise in a more recent chamber study with a simulated altitude of 2438m (66,67). Mean pulmonary artery pressure was significantly higher in COPD patients resident at an altitude of 1768m compared to sea level (36.05mmHg vs 26.78mmHg, p<0.001) (68). Importantly, treatment of other altitude illness may also compound underlying COPD.…”

Section: Chronic Obstructive Pulmonary Disease (Copd)mentioning

confidence: 99%

High altitude respiratory physiology and pathophysiology

Cumpstey¹

2015

SOB

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SummaryAt high altitude, reduced atmospheric pressure causes the partial pressure of oxygen to decreasecreating an environment of hypobaric hypoxia which presents a unique set of challenges for the respiratory system. Pulmonary physiological responses such as the hypoxic ventilatory drive are essential for successful acclimatisation, whilst others such as hypoxic pulmonary vasoconstriction may be implicated in the development of altitude illnesses. Pulmonary conditions are some of the most common (e.g. high altitude cough) and also the most serious illnesses seen at altitude (e.g high altitude pulmonary oedema, HAPE). Minimising the chance of developing HAPE through planning an appropriate ascent profile should be strongly encouraged as HAPE can rapidly be fatal if left untreated. Whilst pharmacological agents such as nifedipine can help with the management of HAPE, rapid descent remains the single-most important treatment option once symptomatic. Given the increasing popularity of travelling to altitude, an awareness of how hypobaric hypoxia affects chronic respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) is also becoming increasingly important for respiratory physicians.

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Right Ventricular Morphology and Function in Chronic Obstructive Pulmonary Disease Patients Living at High Altitude

Cited by 17 publications

References 18 publications

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

Right and Left Heart Function in Lowlanders with COPD at Altitude: Data from a Randomized Study

Right Ventricle and High Altitude

High altitude respiratory physiology and pathophysiology

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