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Original Research: Pulmonary Vascular Disease |

Exercise Pathophysiology in Patients With Chronic Mountain SicknessExercise in Chronic Mountain Sickness

Herman Groepenhoff, MSc; Marieke J. Overbeek, MD; Massimiliano Mulè, MD; Mart van der Plas, MSc; Paola Argiento, MD; Francisco C. Villafuerte, MSc; Sophia Beloka, MSc; Vitalie Faoro, MSc; Jose L. Macarlupu, MSc; Herve Guenard, MD; Claire de Bisschop, MSc; Jean-Benoit Martinot, MD; Rebecca Vanderpool, MSc; Dante Penaloza, MD; Robert Naeije, MD
Author and Funding Information

From the Department of Pulmonology (Mr Groepenhoff and Dr Overbeek), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology (Dr Mulè), University of Catania, Catania, Italy; Department of Respiratory Medicine (Mr van der Plas), Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands; Department of Cardiology (Dr Argiento), Monaldi Hospital, Second University of Naples, Naples, Italy; Department of Medicine and High Altitude Research Institute (Messrs Villafuerte and Macarlupu and Dr Penaloza), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Pathophysiology (Mss Beloka, Faoro, and Vanderpool and Dr Naeije), Faculty of Medicine, Free University of Brussels, Brussels, Belgium; Department of Physiology (Dr Guenard), University Hospital Bordeaux, Bordeaux, France; Laboratory of Physiologic Adaptations to Physical Activities (Ms de Bisschop), Poitiers University, Poitiers, France; and Department of Pneumology (Dr Martinot), St Elisabeth Hospital, Namur, Belgium.

Correspondence to: Robert Naeije, MD, Department of Physiology, Faculty of Medicine, Free University of Brussels, 808, Lennik Road 1070-Brussels, Belgium; e-mail: rnaeije@ulb.ac.be


For editorial comment see page 823

Funding/Support: This study was supported by the Etna Foundation, Catania, Italy, and by a grant from Pfizer, Inc.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):877-884. doi:10.1378/chest.11-2845
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Background:  Chronic mountain sickness (CMS) is characterized by a combination of excessive erythrocytosis, severe hypoxemia, and pulmonary hypertension, all of which affect exercise capacity.

Methods:  Thirteen patients with CMS and 15 healthy highlander and 15 newcomer lowlander control subjects were investigated at an altitude of 4,350 m (Cerro de Pasco, Peru). All of them underwent measurements of diffusing capacity of lung for nitric oxide and carbon monoxide at rest, echocardiography for estimation of mean pulmonary arterial pressure and cardiac output at rest and at exercise, and an incremental cycle ergometer cardiopulmonary exercise test.

Results:  The patients with CMS, the healthy highlanders, and the newcomer lowlanders reached a similar maximal oxygen uptake at 32 ± 1, 32 ± 2, and 33 ± 2 mL/min/kg, respectively, mean ± SE (P = .8), with ventilatory equivalents for Co2 vs end-tidal Pco2, measured at the anaerobic threshold, of 0.9 ± 0.1, 1.2 ± 0.1, and 1.4 ± 0.1 mm Hg, respectively (P < .001); arterial oxygen content of 26 ± 1, 21 ± 2, and 16 ± 1 mL/dL, respectively (P < .001); diffusing capacity for carbon monoxide corrected for alveolar volume of 155% ± 4%, 150% ± 5%, and 120% ± 3% predicted, respectively (P < .001), with diffusing capacity for nitric oxide and carbon monoxide ratios of 4.7 ± 0.1 at sea level decreased to 3.6 ± 0.1, 3.7 ± 0.1, and 3.9 ± 0.1, respectively (P < .05) and a maximal exercise mean pulmonary arterial pressure at 56 ± 4, 42 ± 3, and 31 ± 2 mm Hg, respectively (P < .001).

Conclusions:  The aerobic exercise capacity of patients with CMS is preserved in spite of severe pulmonary hypertension and relative hypoventilation, probably by a combination of increased oxygen carrying capacity of the blood and lung diffusion, the latter being predominantly due to an increased capillary blood volume.

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