Ulrich Silvia, Saxer Stéphanie, Furian Michael, Bader Patrick R, Appenzeller Paula, Scheiwiller Philipp M, Mademilov Maamed, Sheraliev Ulan, Tanner Felix, Sooronbaev Talantbek M, Bloch Konrad E, Lichtblau Mona
Dept of Pulmonology, University Hospital Zurich, Zurich, Switzerland.
These authors contributed equally.
ERJ Open Res. 2021 Apr 6;7(2). doi: 10.1183/23120541.00937-2020. eCollection 2021 Apr.
The aim of the study was to investigate the pulmonary haemodynamic response to exercise in Central Asian high- and lowlanders. This was a cross-sectional study in Central Asian highlanders (living >2500 m) compared with lowlanders (living <800 m), assessing cardiac function, including tricuspid regurgitation pressure gradient (TRPG), cardiac index and tricuspid annular plane systolic excursion (TAPSE) by echocardiography combined with heart rate and oxygen saturation measured by pulse oximetry ( ) during submaximal stepwise cycle exercise (10 W increase per 3 min) at their altitude of residence (at 760 m or 3250 m, respectively). 52 highlanders (26 females; aged 47.9±10.7 years; body mass index (BMI) 26.7±4.6 kg·m; heart rate 75±11 beats·min; 91±5%;) and 22 lowlanders (eight females; age 42.3±8.0 years; BMI 26.9±4.1 kg·m; heart rate 68±7 beats·min; 96±1%) were studied. Highlanders had a lower resting compared to lowlanders but change during exercise was similar between groups (highlanders lowlanders -1.4±2.9% -0.4±1.1%, respectively, p=0.133). Highlanders had a significantly elevated TRPG and exercise-induced increase was significantly higher (13.6±10.5 mmHg 6.1±4.8 mmHg, difference 7.5 (2.8 to 12.2) mmHg; p=0.002), whereas cardiac index increase was slightly lower in highlanders (2.02±0.89 L·min 1.78±0.61 L·min, difference 0.24 (-0.13 to 0.61) L·min; p=0.206) resulting in a significantly steeper pressure-flow ratio (ΔTRPG/Δcardiac index) in highlanders 9.4±11.4 WU and lowlanders 3.0±2.4 WU (difference 6.4 (1.4 to 11.3) WU; p=0.012). Right ventricular-arterial coupling (TAPSE/TRPG) was significantly lower in highlanders but no significant difference in change with exercise in between groups was detected (-0.01 (-0.20 to 0.18); p=0.901). In highlanders, chronic exposure to hypoxia leads to higher pulmonary artery pressure and a steeper pressure-flow relation during exercise.
本研究的目的是调查中亚高海拔和低海拔居民运动时的肺血流动力学反应。这是一项横断面研究，将中亚高海拔居民（居住在海拔>2500米）与低海拔居民（居住在海拔<800米）进行比较，通过超声心动图评估心脏功能，包括三尖瓣反流压力梯度（TRPG）、心脏指数和三尖瓣环平面收缩期位移（TAPSE），同时在其居住海拔（分别为760米或3250米）进行次极量逐步蹬车运动（每3分钟增加10瓦）期间，通过脉搏血氧饱和度仪测量心率和血氧饱和度。研究了52名高海拔居民（26名女性；年龄47.9±10.7岁；体重指数（BMI）26.7±4.6kg·m²；心率75±11次/分钟；血氧饱和度91±5%）和22名低海拔居民（8名女性；年龄42.3±8.0岁；BMI 26.9±4.1kg·m²；心率68±7次/分钟；血氧饱和度96±1%）。与低海拔居民相比，高海拔居民静息时的血氧饱和度较低，但两组运动期间的变化相似（高海拔居民和低海拔居民分别为-1.4±2.9%和-0.4±1.1%，p=0.133）。高海拔居民的TRPG显著升高，运动引起的升高也显著更高（13.6±10.5mmHg比6.1±4.8mmHg，差值7.5（2.8至12.2）mmHg；p=0.002），而高海拔居民心脏指数的增加略低（2.02±0.89L·min⁻¹比1.78±0.61L·min⁻¹，差值0.24（-0.13至0.61）L·min⁻¹；p=0.206），导致高海拔居民的压力-流量比（ΔTRPG/Δ心脏指数）显著更陡，为9.4±11.4WU，低海拔居民为3.0±2.4WU（差值6.4（1.4至11.3）WU；p=0.012）。高海拔居民的右心室-动脉耦联（TAPSE/TRPG）显著更低，但未检测到两组间运动时变化的显著差异（-0.01（-0.20至0.18）；p=0.901）。在高海拔居民中，长期暴露于低氧环境会导致运动时肺动脉压力更高，压力-流量关系更陡。
