Exaggerated pulmonary hypertension and right ventricular dysfunction in high-altitude dwellers with patent foramen ovale.

Brenner, Roman; Pratali, Lorenza; Rimoldi, Stefano; Murillo Jauregui, Carla Ximena; Soria, Rodrigo; Rexhaj, Emrush; Salinas Salmón, Carlos; Villena, Mercedes; Romero, Catherine; Sartori, Claudio; Allemann, Yves; Scherrer, Urs (2015). Exaggerated pulmonary hypertension and right ventricular dysfunction in high-altitude dwellers with patent foramen ovale. Chest, 147(4), pp. 1072-1079. American College of Chest Physicians 10.1378/chest.14-1353

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BACKGROUND There is considerable interindividual variability in pulmonary artery pressure among high-altitude (HA) dwellers, but the underlying mechanism is not known. At low altitude, a patent foramen ovale (PFO) is present in about 25% of the general population. Its prevalence is increased in clinical conditions associated with pulmonary hypertension and arterial hypoxemia, and it is thought to aggravate these problems. METHODS We searched for a PFO (transesophageal echocardiography) in healthy HA dwellers (n = 22) and patients with chronic mountain sickness (n = 35) at 3,600 m above sea level and studied its effects (transthoracic echocardiography) on right ventricular (RV) function, pulmonary artery pressure, and vascular resistance at rest and during mild exercise (50 W), an intervention designed to further increase pulmonary artery pressure. RESULTS The prevalence of PFO (32%) was similar to that reported in low-altitude populations and was not different in participants with and without chronic mountain sickness. Its presence was associated with RV enlargement at rest and an exaggerated increase in right-ventricular-to-right-atrial pressure gradient (25 ± 7 mm Hg vs 15 ± 9 mm Hg, P < .001) and a blunted increase in fractional area change of the right ventricle (3% [-1%, 5%] vs 7% [3%, 16%], P = .008) during mild exercise. CONCLUSIONS These findings show, we believe for the first time, that although the prevalence of PFO is not increased in HA dwellers, its presence appears to facilitate pulmonary vasoconstriction and RV dysfunction during a mild physical effort frequently associated with daily activity. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Rimoldi, Stefano; Rexhaj, Emrush; Allemann, Yves and Scherrer, Urs

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

0012-3692

Publisher:

American College of Chest Physicians

Language:

English

Submitter:

Stefano Rimoldi

Date Deposited:

11 May 2016 10:02

Last Modified:

11 May 2016 10:02

Publisher DOI:

10.1378/chest.14-1353

PubMed ID:

25375664

BORIS DOI:

10.7892/boris.76410

URI:

https://boris.unibe.ch/id/eprint/76410

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