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. 2017 Jan 20;4(1):e000532.
doi: 10.1136/openhrt-2016-000532. eCollection 2017.

Right heart function during simulated altitude in patients with pulmonary arterial hypertension

Leigh M Seccombe  1 , Vincent Chow  2 , Wei Zhao  3 , Edmund M T Lau  4 , Peter G Rogers  5 , Austin C C Ng  2 , Elizabeth M Veitch  5 , Matthew J Peters  1 , Leonard Kritharides  2
Affiliations

Right heart function during simulated altitude in patients with pulmonary arterial hypertension

Leigh M Seccombe et al. Open Heart. .

Abstract

Objective: Patients with pulmonary arterial hypertension (PAH) are often recommended supplemental oxygen for altitude travel due to the possible deleterious effects of hypoxia on pulmonary haemodynamics and right heart function. This includes commercial aircraft travel; however, the direct effects and potential risks are unknown.

Methods: Doppler echocardiography and gas exchange measures were investigated in group 1 patients with PAH and healthy patients at rest breathing room air and while breathing 15.1% oxygen, at rest for 20 min and during mild exertion.

Results: The 14 patients with PAH studied were clinically stable on PAH-specific therapy, with functional class II (n=11) and III (n=3) symptoms when tested. Measures of right ventricular size and function were significantly different in the PAH group at baseline as compared to 7 healthy patients (p<0.04). There was no evidence of progressive right ventricular deterioration during hypoxia at rest or under exertion. Pulmonary arterial systolic pressure (PASP) increased in both groups during hypoxia (p<0.01). PASP in hypoxia correlated strongly with baseline PASP (p<0.01). Pressure of arterial oxygen correlated with PASP in hypoxia (p<0.03) but not at baseline, with three patients with PAH experiencing significant desaturation. The duration and extent of hypoxia in this study was tolerated well despite a mild increase in symptoms of breathlessness (p<0.01).

Conclusions: Non-invasive measures of right heart function in group 1 patients with PAH on vasodilator treatment demonstrated a predictable rise in PASP during short-term simulated hypoxia that was not associated with a deterioration in right heart function.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Correlation of pulmonary artery systolic pressure (PASP) and pressure of arterial oxygen (PaO2) during resting hypoxia in 11 patients with pulmonary arterial hypertension.
Figure 2
Figure 2
Mean pulmonary arterial systolic pressure (PASP) with 95% CI error bars and individual data points at rest breathing room air (baseline), during 20 min breathing 15.1% O2 at rest (hypoxia rest) and following mild exercise (hypoxia exercise) in 14 patients with pulmonary arterial hypertension (PAH) and 7 healthy patients (control). *p<0.01 ANOVA, †Vs Control p<0.01, unpaired t-test. N=11 PAH hypoxia during exercise. ANOVA, analysis of variance; PAH, pulmonary arterial hypertension.
Figure 3
Figure 3
Mean with 95% CI error bars and individual data points of right ventricular function parameters at rest breathing room air (baseline), during 20 min breathing 15.1% O2 at rest (hypoxia rest) and following mild exercise (hypoxia exercise) in 14 patients with pulmonary arterial hypertension (PAH) and 7 healthy patients (control). *p<0.03 ANOVA, †Vs Control p<0.04, unpaired t-test. N=11 PAH hypoxia during exercise. ANOVA, analysis of variance; FAC, fractional area change; PAH, pulmonary arterial hypertension; RV, right ventricular;.
See this image and copyright information in PMC

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