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Original Research: Pulmonary Vascular Disease |

Exaggerated Pulmonary Hypertension and Right Ventricular Dysfunction in High-Altitude Dwellers With Patent Foramen OvaleHigh-Altitude Dwellers With Patent Foramen Ovale

Roman Brenner, MD; Lorenza Pratali, MD; Stefano F. Rimoldi, MD; Carla Ximena Murillo Jauregui, MD; Rodrigo Soria, MD; Emrush Rexhaj, MD; Carlos Salinas Salmón, MD; Mercedes Villena, MD; Catherine Romero, BS; Claudio Sartori, MD; Yves Allemann, MD; Urs Scherrer, MD
Author and Funding Information

From the Department of Cardiology and Clinical Research (Drs Brenner, Rimoldi, Soria, Rexhaj, and Allemann and Prof Scherrer), University Hospital Bern, Bern, Switzerland; the Institute of Clinical Physiology (Dr Pratali), Pisa, Italy; Instituto Boliviano de Biologia de Altura (Drs Murillo Jauregui, Salinas Salmón, and Villena and Ms Romero), La Paz, Bolivia; the Department of Internal Medicine (Dr Sartori), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; and Facultad de Ciencias (Prof Scherrer), Departamento de Biología, Universidad de Tarapacá, Arica, Chile.

CORRESPONDENCE TO: Urs Scherrer, MD, Cardiology, University Hospital Bern, 3011 Bern, Switzerland; e-mail: urs.scherrer2@insel.ch


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

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


Chest. 2015;147(4):1072-1079. doi:10.1378/chest.14-1353
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BACKGROUND:  There is considerable interindividual variability in pulmonary artery pressure among high-altitude (HA) dwellers, but the underlying mechanism is not known. At low altitude, a patent foramen ovale (PFO) is present in about 25% of the general population. Its prevalence is increased in clinical conditions associated with pulmonary hypertension and arterial hypoxemia, and it is thought to aggravate these problems.

METHODS:  We searched for a PFO (transesophageal echocardiography) in healthy HA dwellers (n = 22) and patients with chronic mountain sickness (n = 35) at 3,600 m above sea level and studied its effects (transthoracic echocardiography) on right ventricular (RV) function, pulmonary artery pressure, and vascular resistance at rest and during mild exercise (50 W), an intervention designed to further increase pulmonary artery pressure.

RESULTS:  The prevalence of PFO (32%) was similar to that reported in low-altitude populations and was not different in participants with and without chronic mountain sickness. Its presence was associated with RV enlargement at rest and an exaggerated increase in right-ventricular-to-right-atrial pressure gradient (25 ± 7 mm Hg vs 15 ± 9 mm Hg, P < .001) and a blunted increase in fractional area change of the right ventricle (3% [−1%, 5%] vs 7% [3%, 16%], P = .008) during mild exercise.

CONCLUSIONS:  These findings show, we believe for the first time, that although the prevalence of PFO is not increased in HA dwellers, its presence appears to facilitate pulmonary vasoconstriction and RV dysfunction during a mild physical effort frequently associated with daily activity.

TRIAL REGISTRY:  ClinicalTrials.gov; No.: NCT01182792; URL: www.clinicaltrials.gov

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