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Pulmonary vascular disease
Original research article
Right heart function during simulated altitude in patients with pulmonary arterial hypertension
  1. Leigh M Seccombe1,2,
  2. Vincent Chow2,3,
  3. Wei Zhao3,
  4. Edmund M T Lau2,
  5. Peter G Rogers1,
  6. Austin C C Ng2,3,
  7. Elizabeth M Veitch1,
  8. Matthew J Peters1,2 and
  9. Leonard Kritharides2,3
  1. 1Department of Thoracic Medicine, Concord Repatriation General Hospital, Concord, New South Wales, Australia
  2. 2Sydney Medical School, The University of Sydney, Sydney, Australia
  3. 3Department of Cardiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
  1. Correspondence to Dr Leigh M Seccombe; leigh.seccombe{at}sswahs.nsw.gov.au

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.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000532

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    Footnotes

    • Competing interests None declared.

    • Ethics approval Sydney Local Area Health District, New South Wales, Australia, HREC.

    • Provenance and peer review Not commissioned; internally peer reviewed.