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Pulmonary haemodynamic response to exercise in highlanders versus lowlanders

Silvia Ulrich, Stéphanie Saxer, Michael Furian, Patrick R. Bader, Paula Appenzeller, Philipp M. Scheiwiller, Maamed Mademilov, Ulan Sheraliev, Felix Tanner, Talantbek M. Sooronbaev, Konrad E. Bloch, Mona Lichtblau
ERJ Open Research 2021 7: 00937-2020; DOI: 10.1183/23120541.00937-2020
Silvia Ulrich
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
4These authors contributed equally
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  • For correspondence: silvia.ulrich@usz.ch
Stéphanie Saxer
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
4These authors contributed equally
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Michael Furian
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Patrick R. Bader
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Paula Appenzeller
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Philipp M. Scheiwiller
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Maamed Mademilov
2National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
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Ulan Sheraliev
2National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
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Felix Tanner
3Dept of Cardiology, University Hospital Zurich, Zurich, Switzerland
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Talantbek M. Sooronbaev
2National Center for Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
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Konrad E. Bloch
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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Mona Lichtblau
1Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland
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  • FIGURE 1
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    FIGURE 1

    Patient flow. GOLD: Global Initiative for Chronic Obstructive Lung Disease.

  • FIGURE 2
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    FIGURE 2

    Pressure–flow relationship displayed as tricuspid regurgitation pressure gradient (TRPG) in relation to the cardiac index from baseline to end-exercise, reflecting the pressure/flow relationship for (a) highlanders and lowlanders and (b) all groups: lowlanders, no high-altitude pulmonary hypertension (HAPH; resting mean pulmonary artery pressure mPAP<20 mmHg), borderline HAPH (resting mPAP 20–30 mmHg) and HAPH (resting mPAP>30 mmHg).

  • FIGURE 3
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    FIGURE 3

    Vital signs of the lowlanders and highlanders during exercise (baseline, 3 min, 6 min, 9 min and individual end exercise). TAPSE: tricuspid annular plane systolic excursion; TRPG: tricuspid regurgitation pressure gradient.

Tables

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  • TABLE 1

    Baseline characteristics

    Lowlanders n=22Highlanders n=52p-value
    Male/female n14/826/26
    Age years42.3±8.047.9±10.70.033
    Height cm168.5±10.4162.2±9.40.014
    Weight kg75.9±10.470.2±13.40.078
    BMI kg·m−226.9±4.126.7±4.60.845
    Body surface area m21.89±0.161.75±0.190.017
    Heart rate beats·min−168±775±110.010
    Blood pressure systolic mmHg121±15127±230.274
    Blood pressure diastolic mmHg82±1085±120.348
    New York Heart Association functional class I/II/III18/3/130/18/40.379
    Workload achieved Watts48±1145±140.344
    SpO2 %96±191±5<0.001
    Haemoglobin concentration g·dL−114.4±1.716.0±2.30.008
    Haematocrit %39.1±5.046.8±7.6<0.001
    PaO2 mmHg79.3±10.956.2±6.2<0.001
    PaCO2 mmHg38.9±2.932.5±2.8<0.001
    Oxygen content mL O2·dL−118.3±2.418.9±2.80.447
    Pack-years1.9±5.23.7±6.20.227

    Data are presented as mean±sd, unless otherwise stated. BMI: Body mass index; SpO2: oxygen saturation by pulse oximetry; PaO2: partial pressure of arterial oxygen; PaCO2: partial pressure of arterial carbon dioxide.

    • TABLE 2

      Between-group differences of the pressure–flow slope

      LowlandersHighlandersBetween group differencesp-value
      Subjects n2252
      ΔTRPG/ΔCI WU3.0±2.49.4±11.46.4 (1.4 to 11.3)0.012
      ΔmPAP/ΔCO WU1.0±0.83.3±3.82.3 (0.6 to 3.9)0.007

      Data are presented as mean±sd or mean difference (95% CI), unless otherwise stated. TRPG: tricuspid regurgitation pressure gradient; CI: cardiac index; mPAP: mean pulmonary artery pressure; CO: cardiac output.

      • TABLE 3

        Assessment during stepwise exercise

        LowlandersHighlandersBetween group differencep-value
        Subjects2252
        SpO2 %
         Baseline96±291±3−5 (−6 to −4)<0.001
         End-exercise95±189±3−6 (−8 to −5)<0.001
         End-exercise−baseline−0.4±1.1−1.4±2.9−1.0 (−2.2 to 0.3)0.133
        Heart rate beats·min−1
         Baseline77±1382±125 (−2 to 11)0.137
         End-exercise101±15110±149 (2 to 16)0.012
         End-exercise−baseline24±1528±13−4 (−2 to 11)0.185
        TRPG mmHg
         Baseline13.9±4.222.8±5.58.9 (6.3 to 11.5)<0.001
         End-exercise20.0±7.436.4±12.216.4 (10.8 to 21.9)<0.001
         End-exercise−baseline6.1±4.813.6±10.57.5 (2.8 to 12.2)0.002
        Cardiac index L·min·m−2
         Baseline1.98±0.472.36±0.58−0.38 (−0.66 to −0.09)0.011
         End-exercise4.00±1.174.14±0.78−0.14 (−0.62 to 0.34)0.566
         End-exercise−baseline2.02±0.891.78±0.610.24 (−0.13 to 0.61)0.206
        SVI L·min·m−2
         Baseline26.0±5.429.2±6.8−3.3 (−6.6 to 0.1)0.055
         End-exercise38.6±6.637.8±6.30.8 (−2.5 to 4.1)0.634
         End-exercise−baseline12.6±3.79.3±7.53.4 (0.0 to 6.8)0.052
        TAPSE cm
         Baseline2.1±0.31.9±0.4−0.1 (−0.3 to 0.1)0.153
         End-exercise2.7±0.42.5±0.5−0.2 (−0.4 to 0.1)0.163
         End-exercise−baseline0.6±0.40.6±0.40.0 (−0.2 to 0.2)0.739
        FAC %
         Baseline42.7±5.541.7±8.11.0 (−6.3 to 4.2)0.691
         End-exercise50.0±7.044.0±7.7−6.0 (−11.3 to −0.8)0.024
         End-exercise−baseline7.8±7.53.9±12.0−3.9 (−12.7 to 5.0)0.380
        RVEDA cm2
         Baseline13.4±2.218.1±3.74.7 (2.4 to 7.1)<0.001
         End-exercise17.6±2.719.5±3.41.8 (−0.4 to 4.1)0.112
         End-exercise−baseline3.5±1.81.8±4.3−1.7 (−4.7 to 1.4)0.275
        RVESA cm2
         Baseline7.7±1810.6±2.92.9 (1.0 to 4.8)0.003
         End-exercise8.9±2.510.9±2.22.0 (0.4 to 3.6)0.014
         End-exercise−baseline0.6±1.30.2±3.1−0.4 (−2.6 to 1.8)0.707
        TAPSE/TRPG mm·mmHg−1
         Baseline1.6±0.50.9±0.1−0.7 (−0.9 to −0.4)<0.001
         End-exercise1.6±0.80.8±0.3−0.8 (−1.0 to −0.5)<0.001
         End-exercise−baseline−0.1±0.4−0.1±0.3−0.01 (−0.20 to 0.18)0.901
        TAPSE/sPAP mm·mmHg−1
         Baseline1.1±0.30.7±0.2−0.39 (−0.52 to −0.26)<0.001
         End-exercise1.2±0.50.7±0.3−0.50 (−0.67 to −0.34)<0.001
         End-exercise−baseline−0.01±0.26−0.06±0.23−0.04 (−0.17 to 0.09)0.515
        BPs mmHg
         Baseline104±19112±157 (−1 to 15)0.094
         End-exercise123±20133±239 (−2 to 20)0.095
         End-exercise−baseline19±1221±172 (−6 to 10)0.579
        BPd mmHg
         Baseline70±1177±107 (1 to 12)0.015
         End-exercise68±1478±1310 (3 to 17)0.004
         End-exercise−baseline−2±82±124 (−2 to 9)0.191

        Data are presented as n, mean±sd or mean difference (95% CI), unless otherwise stated.

        Baseline: baseline upright on cycle ergometer; end-exercise: values at end exercise; SpO2: oxygen saturation by pulse oximetry; TRPG: tricuspid regurgitation pressure gradient; SVI: stroke volume index; TAPSE: tricuspid annular plane systolic excursion; FAC: fractional area change; RVEDA: right ventricle end-diastolic area; RVESA: right ventricle end-systolic area; sPAP: systolic pulmonary artery pressure; BPs: blood pressure systolic; BPd: blood pressure diastolic.

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          Supplementary material 00937-2020.SUPPLEMENT

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        Pulmonary haemodynamic response to exercise in highlanders versus lowlanders
        Silvia Ulrich, Stéphanie Saxer, Michael Furian, Patrick R. Bader, Paula Appenzeller, Philipp M. Scheiwiller, Maamed Mademilov, Ulan Sheraliev, Felix Tanner, Talantbek M. Sooronbaev, Konrad E. Bloch, Mona Lichtblau
        ERJ Open Research Apr 2021, 7 (2) 00937-2020; DOI: 10.1183/23120541.00937-2020

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        Pulmonary haemodynamic response to exercise in highlanders versus lowlanders
        Silvia Ulrich, Stéphanie Saxer, Michael Furian, Patrick R. Bader, Paula Appenzeller, Philipp M. Scheiwiller, Maamed Mademilov, Ulan Sheraliev, Felix Tanner, Talantbek M. Sooronbaev, Konrad E. Bloch, Mona Lichtblau
        ERJ Open Research Apr 2021, 7 (2) 00937-2020; DOI: 10.1183/23120541.00937-2020
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