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Copyright ©ERS Journals Ltd 2005
Identification of individuals susceptible to high-altitude pulmonary oedema at low altitude
1 Division of Sports Medicine, and 2 Dept of Cardiology, Internal Medicine, University Hospital, Heidelberg, Germany, 3 Authors contributed equally to the study.
CORRESPONDENCE: C. Dehnert, Dept of Internal Medicine VII, Sports Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany. Fax: 49 6221566931. E-mail: christoph.dehnert@med.uni-heidelberg.de
Keywords: Doppler echocardiography, exercise, hypoxia, hypoxic ventilatory response, lung volumes, pulmonary artery pressure
Received: June 13, 2004
Accepted October 31, 2004
Individuals susceptible to high-altitude pulmonary oedema (HAPE) are characterised by an abnormal increase of pulmonary artery systolic pressure (PASP) in hypoxia and during normoxic exercise, reduced hypoxic ventilatory response, and smaller lung volume.
In 37 mountaineers with well-documented altitude tolerance, it was investigated whether any combination of these noninvasive measurements, including exercise in hypoxia, could improve the identification of HAPE-susceptible subjects at low altitude.
HAPE-susceptible subjects showed a significant higher increase of PASP during hypoxia at rest (48±10 mmHg) compared with controls (38±3 mmHg), as well as during normoxic exercise (57±14 versus 38±7 mmHg) and hypoxic exercise (69±13 versus 49±8 mmHg). PASP could not be assessed in three and eight subjects during normoxic or hypoxic exercise, respectively, due to insufficient Doppler profiles or systemic arterial hypertension. Sensitivity (77–94%) and specificity (76–93%) were not significantly different between the various testing conditions. Additional assessment of hypoxic ventilatory response and lung function parameters did not improve identification of HAPE-susceptible subjects in a multivariate analysis.
Due to the greater number of missing values in pulmonary artery systolic pressure measurements during hypoxic exercise, it was concluded that pulmonary artery systolic pressure measurements at rest during hypoxia or exercise in normoxia are most feasible for the identification of high-altitude pulmonary oedema-susceptible subjects.
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