Kafkas University School of Medicine, Kars, Turkey.
Heart Lung Circ. 2013 Jan;22(1):31-7. doi: 10.1016/j.hlc.2012.08.004. Epub 2012 Sep 2.
Pulmonary vasculature is affected in patients with chronic pulmonary obstructive disease (COPD). As a result of increased pulmonary resistance, right ventricular morphology and function are altered in COPD patients. High altitude and related hypoxia causes pulmonary vasoconstriction, thereby affecting the right ventricle. We aimed to investigate the combined effects of COPD and altitude-related chronic hypoxia on right ventricular morphology and function.
Forty COPD patients living at high altitude (1768 m) and 41 COPD patients living at sea level were enrolled in the study. All participants were diagnosed as COPD by a pulmonary diseases specialist depending on symptoms, radiologic findings and pulmonary function test results. Detailed two-dimensional echocardiography was performed by a cardiologist at both study locations.
Oxygen saturation and mean pulmonary artery pressure were higher in the high altitude group. Right ventricular end diastolic diameter, end systolic diameter, height and end systolic area were significantly higher in the high altitude group compared to the sea level group. Parameters of systolic function, including tricuspid annular systolic excursion, systolic velocity of tricuspid annulus and right ventricular isovolumic acceleration were similar between groups, while fractional area change was significantly higher in the sea level groups compared to the high altitude group. Indices of diastolic function and myocardial performance index were similar between groups.
An increase in mean pulmonary artery pressure and right ventricular dimensions are observed in COPD patients living at high altitude. Despite this increase, systolic and diastolic functions of the right ventricle, as well as global right ventricular performance are similar in COPD patients living at high altitude and sea level. Altitude-related adaptation to chronic hypoxia could explain these findings.
慢性阻塞性肺疾病（COPD）患者的肺血管会受到影响。由于肺阻力增加，COPD 患者的右心室形态和功能会发生改变。高海拔和相关的低氧会导致肺血管收缩，从而影响右心室。我们旨在研究 COPD 和与海拔相关的慢性低氧对右心室形态和功能的综合影响。
本研究纳入了 40 名居住在高海拔（1768 米）的 COPD 患者和 41 名居住在海平面的 COPD 患者。所有患者均由肺病专家根据症状、影像学发现和肺功能检查结果诊断为 COPD。在两个研究地点，由心脏病专家进行详细的二维超声心动图检查。
高海拔组的氧饱和度和平均肺动脉压较高。与海平面组相比，高海拔组的右心室舒张末期直径、收缩末期直径、高度和收缩末期面积明显更大。收缩功能参数，包括三尖瓣环收缩期位移、三尖瓣环收缩期速度和右心室等容加速度在两组之间相似，而分数面积变化在海平面组明显高于高海拔组。两组之间的舒张功能指数和心肌做功指数相似。
在居住在高海拔的 COPD 患者中，平均肺动脉压和右心室尺寸增加。尽管存在这种增加，但居住在高海拔和海平面的 COPD 患者的右心室收缩和舒张功能以及整体右心室功能相似。与海拔相关的对慢性低氧的适应可能解释了这些发现。
