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Original Research: PULMONARY HYPERTENSION |

Exaggerated Pulmonary Hypertension During Mild Exercise in Chronic Mountain Sickness

Thomas Stuber, MD; Claudio Sartori, MD; Marcos Schwab, MD; Pierre-Yves Jayet, MD; Stefano F. Rimoldi, MD; Sophie Garcin, MD; Sébastien Thalmann, MD; Hilde Spielvogel, MD; Carlos Salinas Salmòn, MD; Mercedes Villena, MD; Urs Scherrer, MD; Yves Allemann, MD
Author and Funding Information

From the University Hospital of Bern, Cardiology (Drs Stuber, Rimoldi, and Allemann), Bern, Switzerland; Department of Internal Medicine and Botnar Center for Clinical Research (Drs Sartori, Schwab, Jayet, Garcin, Thalmann, and Scherrer), University Hospital, Lausanne, Switzerland; and Instituto Boliviano de Biologia de Altura (Drs Spielvogel, Salmòn, and Villena), La Paz, Bolivia.

Correspondence to: Yves Allemann, MD, Swiss Cardiovascular Center Bern, University Hospital, CH-3010 Bern, Switzerland; e-mail: yves.allemann@insel.ch


Funding/Support: This work was supported by grants from the Swiss National Science Foundation, the Prof Dr Max Cloëtta Foundation, the Placide Nicod Foundation, the CardioMet Foundation, the Leenaards Foundation, the Novartis Foundation, and the Eagle Foundation.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(2):388-392. doi:10.1378/chest.09-1355
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Background:  Chronic mountain sickness (CMS) is an important public health problem and is characterized by exaggerated hypoxemia, erythrocytosis, and pulmonary hypertension. While pulmonary hypertension is a leading cause of morbidity and mortality in patients with CMS, it is relatively mild and its underlying mechanisms are not known. We speculated that during mild exercise associated with daily activities, pulmonary hypertension in CMS is much more pronounced.

Methods:  We estimated pulmonary artery pressure by using echocardiography at rest and during mild bicycle exercise at 50 W in 30 male patients with CMS and 32 age-matched, healthy control subjects who were born and living at an altitude of 3,600 m.

Results:  The modest, albeit significant difference of the systolic right-ventricular-to-right-atrial pressure gradient between patients with CMS and controls at rest (30.3 ± 8.0 vs 25.4 ± 4.5 mm Hg, P 5 .002) became more than three times larger during mild bicycle exercise (56.4 ± 19.0 vs 39.8 ± 8.0 mm Hg, P < .001).

Conclusions:  Measurements of pulmonary artery pressure at rest greatly underestimate pulmonary artery pressure during daily activity in patients with CMS. The marked pulmonary hypertension during mild exercise associated with daily activity may explain why this problem is a leading cause of morbidity and mortality in patients with CMS.

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