Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
Am J Cardiol. 2019 Jun 15;123(12):2022-2025. doi: 10.1016/j.amjcard.2019.03.030. Epub 2019 Mar 18.
Over 50% of patients who rapidly ascend to extreme altitudes develop various symptoms known as acute mountain sickness (AMS), which rarely can be life threatening. It is unclear why some patients are more susceptible to AMS than others. Our objective was to determine whether patent foramen ovale (PFO) is a risk factor for AMS. Subjects who had hiked to altitudes above 10,000' (∼3,000 meters) on the John Muir Trail in California were recruited. Participants completed a questionnaire and 2-physician adjudication was performed in regard to AMS status. A transcranial Doppler with agitated saline contrast injection was performed to evaluate the presence or absence of PFO. The primary outcome was the development of AMS. From 2016 to 2018, 137 hikers were recruited into the study. There was a higher prevalence of PFO in hikers with AMS 15 of 24 (63%) compared with hikers without AMS 44 of 113 (39%); p = 0.034. In the multivariate model, the presence of a PFO significantly increased the risk for developing AMS: odds ratio 4.15, 95% confidence intervals 1.14 to 15.05; p = 0.030. In conclusion, hikers with a PFO had significantly higher risk of developing AMS relative to hikers without a PFO. Clinicians should consider PFO a risk factor in patients who plan to hike to high altitudes.
超过 50%的快速上升到极高海拔的患者会出现各种被称为急性高原病（AMS）的症状，这种疾病很少会有生命危险。目前尚不清楚为什么有些患者比其他患者更容易患上 AMS。我们的目的是确定卵圆孔未闭（PFO）是否是 AMS 的一个危险因素。研究对象是那些曾在加利福尼亚州约翰缪尔小径上攀登到海拔 10000 英尺（约 3000 米）以上的人。参与者完成了一份问卷，由两名医生对 AMS 状况进行了裁决。通过经颅多普勒超声和搅动盐水对比注射来评估 PFO 的存在或不存在。主要结果是 AMS 的发生。2016 年至 2018 年，共有 137 名徒步旅行者被招募参与这项研究。患有 AMS 的徒步旅行者中 PFO 的发生率更高，24 名中有 15 名（63%），而没有 AMS 的徒步旅行者 113 名中有 44 名（39%）；p=0.034。在多变量模型中，PFO 的存在显著增加了发生 AMS 的风险：优势比 4.15，95%置信区间 1.14 至 15.05；p=0.030。总之，与没有 PFO 的徒步旅行者相比，有 PFO 的徒步旅行者发生 AMS 的风险明显更高。临床医生应考虑将 PFO 作为计划前往高海拔地区徒步旅行的患者的一个危险因素。
