The effect of high altitude (2500 m) on incremental cycling exercise in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a randomised controlled crossover trial,European Respiratory Journal

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The effect of high altitude (2500 m) on incremental cycling exercise in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: a randomised controlled crossover trial
European Respiratory Journal ( IF 24.3 ) Pub Date : 2024-03-07 , DOI: 10.1183/13993003.01001-2023
Julian Müller , Anna Titz , Simon R. Schneider , Meret Bauer , Laura Mayer , Lea Lüönd , Tanja Ulrich , Michael Furian , Aglaia Forrer , Esther I. Schwarz , Konrad E. Bloch , Mona Lichtblau , Silvia Ulrich

Background

Our objective was to investigate the effect of a day-long exposure to high altitude on peak exercise capacity and safety in stable patients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

In a randomised controlled crossover trial, stable patients with PAH or distal CTEPH without resting hypoxaemia at low altitude performed two incremental exercise tests to exhaustion: one after 3–5 h at high altitude (2500 m) and one at low altitude (470 m).

Results

In 27 patients with PAH/CTEPH (44% females, mean±sd age 62±14 years), maximal work rate was 110±64 W at 2500 m and 123±64 W at 470 m (–11%, 95% CI –16– –11%; p<0.001). Oxygen saturation measured by pulse oximetry and arterial oxygen tension at end-exercise were 83±6% versus 91±6% and 6.1±1.9 versus 8.6±1.9 kPa (–8% and –29%; both p<0.001) at 2500 versus 470 m, respectively. Maximal oxygen uptake was 17.8±7.5 L·min^–1·kg^–1 at high altitude versus 20±7.4 L·min^–1·kg^–1 at low altitude (–11%; p<0.001). At end-exercise, the ventilatory equivalent for carbon dioxide was 43±9 at 2500 m versus 39±9 at 470 m (9%, 95% CI 2–6%; p=0.002). No adverse events occurred during or after exercise.

Conclusions

Among predominantly low-risk patients with stable PAH/CTEPH, cycling exercise during the first day at 2500 m was well tolerated, but peak exercise capacity, blood oxygenation and ventilatory efficiency were lower compared with 470 m.

中文翻译：

高海拔（2500 m）对肺动脉高压和慢性血栓栓塞性肺动脉高压患者增量自行车运动的影响：随机对照交叉试验

背景

我们的目的是调查一整天的高海拔暴露对稳定的肺动脉高压（PAH）和慢性血栓栓塞性肺动脉高压（CTEPH）患者的峰值运动能力和安全性的影响。

方法

在一项随机对照交叉试验中，患有 PAH 或远端 CTEPH 且无低海拔静息低氧血症的稳定患者进行了两次增量运动测试至力竭：一次在高海拔 (2500 m) 3-5 小时后进行，另一次在低海拔 (470 m) 。

结果

27 名 PAH/CTEPH 患者（44% 为女性，平均值±标准差年龄 62±14 岁），2500 m 处的最大功率为 110±64 W，470 m 处为 123±64 W（–11%，95% CI –16– –11%；p<0.001）。运动结束时通过脉搏血氧饱和度和动脉氧张力测量的氧饱和度分别为 83±6%与91±6% 和 6.1±1.9与8.6±1.9 kPa（–8% 和 –29%；均p<0.001）。分别为 470 m。高海拔地区最大摄氧量为 17.8±7.5 L·min ^–1 ·kg ^–1 ，低海拔地区为20±7.4 L·min ^–1 ·kg ^–1 (–11%；p<0.001)。运动结束时，二氧化碳的通气当量在 2500 m 时为 43±9，而在 470 m 时为 39±9（9%，95% CI 2–6%；p=0.002）。运动期间或运动后没有发生不良事件。