Cardiovascular Indicators of Systemic Circulation and Acute Mountain Sickness: An Observational Cohort Study

Renzheng Chen; Mengjia Sun; Jie Yang; Chuan Liu; Jihang Zhang; Jingbin Ke; Yuhan Deng; Chunyan He; Yuanqi Yang; Ran Cheng; Fangzhengyuan Yuan; Hu Tan; Xubin Gao; Lan Huang

doi:10.3389/fphys.2021.708862

Cardiovascular Indicators of Systemic Circulation and Acute Mountain Sickness: An Observational Cohort Study

Front Physiol. 2021 Aug 27:12:708862. doi: 10.3389/fphys.2021.708862. eCollection 2021.

Authors

Renzheng Chen^{1

2}, Mengjia Sun^{1

2}, Jie Yang^{1

2}, Chuan Liu^{1

2}, Jihang Zhang^{1

2}, Jingbin Ke^{1

2}, Yuhan Deng^{1

2}, Chunyan He^{1

2}, Yuanqi Yang^{1

2}, Ran Cheng^{1

2}, Fangzhengyuan Yuan^{1

2}, Hu Tan^{1

2}, Xubin Gao^{1

2}, Lan Huang^{1

2}

Affiliations

¹ Institute of Cardiovascular Diseases of Chinese People's Liberation Army, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.
² Department of Cardiology, The Second Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing, China.

Abstract

Background: Acute high-altitude (HA) exposure results in blood pressure (BP) and cardiac function variations in most subjects, some of whom suffer from acute mountain sickness (AMS). Several previous studies have found that cardiovascular function indicators are potentially correlated with AMS. Objectives: This study aims to examine HA-induced cardiovascular adaptations in AMS patients and compare them with healthy subjects. It also aims to investigate the relationship between cardiovascular function indicators and AMS, as well as to provide some insightful information about the prevention and treatment of AMS. Methods: Seventy-two subjects were enrolled in this cohort study. All the subjects ascended Litang (4,100 m above sea level). They were monitored by a 24-h ambulatory blood pressure (ABP) device and underwent echocardiography examination within 24 h of altitude exposure. The 2018 Lake Louise questionnaire was used to evaluate AMS. Results: Acute mountain sickness group consisted of more women (17 [60.7%] vs. 10 [22.7%], p = 0.001) and fewer smokers (5 [17.9%] vs. 23 [52.3%], p = 0.003). Compared with subjects without AMS, subjects with AMS had lower pulse pressure (PP) (daytime PP, 45.23 ± 7.88 vs. 52.14 ± 4.75, p < 0.001; nighttime PP, 42.81 ± 5.92 vs. 49.39 ± 7.67, p < 0.001) and lower effective arterial elastance (Ea) (1.53 ± 0.24 vs. 1.73 ± 0.39, p = 0.023). Multivariate regression indicated that female sex (OR = 0.23, p = 0.024), lower daytime PP (OR = 0.86, p = 0.004), and lower Ea (OR = 0.03, p = 0.015) at low altitude (LA) were independent risk factors for AMS. Combined daytime PP and Ea at LA had a high predictive value for AMS (AUC = 0.873; 95% CI: 0.789-0.956). Correlation analysis showed that AMS-induced headache correlated with daytime PP (R = -0.401, p < 0.001) and nighttime PP at LA (R = -0.401, p < 0.001). Conclusion: Our study demonstrated that AMS patients had a lower PP and Ea at LA. These baseline indicators of vasodilation at LA were closely associated with AMS, which may explain the higher headache severity in subjects with higher PP at LA.

Keywords: acute mountain sickness; ambulatory blood pressure; cardiac ultrasound; cardiovascular indicators of systemic circulation; high altitude.