Staempfli Roger, Schmid Jean-Paul, Schenker Stephan, Eser Prisca, Trachsel Lukas D, Deluigi Christina, Wustmann Kerstin, Thomet Corina, Greutmann Matthias, Tobler Daniel, Stambach Dominik, Wilhelm Matthias, Schwerzmann Markus
Department of Cardiology, Preventive Cardiology and Sports Medicine, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiology, Center for Congenital Heart Disease, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
Heart. 2016 Aug 15;102(16):1296-301. doi: 10.1136/heartjnl-2016-309682. Epub 2016 May 23.
High altitude-related hypoxia induces pulmonary vasoconstriction. In Fontan patients without a contractile subpulmonary ventricle, an increase in pulmonary artery pressure is expected to decrease circulatory output and reduce exercise capacity. This study investigates the direct effects of short-term high altitude exposure on pulmonary blood flow (PBF) and exercise capacity in Fontan patients.
16 adult Fontan patients (mean age 28±7 years, 56% female) and 14 matched controls underwent cardiopulmonary exercise testing with measurement of PBF with a gas rebreathing system at 540 m (low altitude) and at 3454 m (high altitude) within 12 weeks.
PBF at rest and at exercise was higher in controls than in Fontan patients, both at low and high altitude. PBF increased twofold in Fontan patients and 2.8-fold in the control group during submaximal exercise, with no significant difference between low and high altitude (p=0.290). A reduction in peak oxygen uptake at high compared with low altitude was observed in Fontan patients (22.8±5.1 and 20.5±3.8 mL/min/kg, p<0.001) and the control group (35.0±7.4 and 29.1±6.5 mL/min/kg, p<0.001). The reduction in exercise capacity was less pronounced in Fontan patients compared with controls (9±12% vs 17±8%, p=0.005). No major adverse clinical event was observed.
Short-term high altitude exposure has no negative impact on PBF and exercise capacity in Fontan patients when compared with controls, and was clinically well tolerated.
NCT02237274: Results.
与高海拔相关的缺氧会诱发肺血管收缩。在没有收缩性肺下心室的Fontan患者中，肺动脉压力升高预计会降低循环输出并降低运动能力。本研究调查短期高海拔暴露对Fontan患者肺血流量（PBF）和运动能力的直接影响。
16名成年Fontan患者（平均年龄28±7岁，56%为女性）和14名匹配的对照组在12周内于海拔540米（低海拔）和3454米（高海拔）进行了心肺运动测试，使用气体重呼吸系统测量PBF。
在低海拔和高海拔时，对照组静息和运动时的PBF均高于Fontan患者。在次最大运动期间，Fontan患者的PBF增加了两倍，对照组增加了2.8倍，低海拔和高海拔之间无显著差异（p=0.290）。Fontan患者和对照组在高海拔时的峰值摄氧量均低于低海拔时（Fontan患者：22.8±5.1和20.5±3.8 mL/min/kg，p<0.001；对照组：35.0±7.4和29.1±6.5 mL/min/kg，p<0.001）。与对照组相比，Fontan患者运动能力的下降不太明显（9±12%对17±8%，p=0.005）。未观察到重大不良临床事件。
与对照组相比，短期高海拔暴露对Fontan患者的PBF和运动能力没有负面影响，且临床耐受性良好。
NCT02237274：结果。
