Altered Left Ventricular Geometry and Torsional Mechanics in High Altitude-Induced Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

Bart W De Boeck; Aurel Toma; Stephanie Kiencke; Christoph Dehnert; Stefanie Zügel; Christoph Siebenmann; Katja Auinger; Peter T Buser; Marco Maggiorini; Beat A Kaufmann

doi:10.1016/j.echo.2017.12.001

Altered Left Ventricular Geometry and Torsional Mechanics in High Altitude-Induced Pulmonary Hypertension: A Three-Dimensional Echocardiographic Study

J Am Soc Echocardiogr. 2018 Mar;31(3):314-322. doi: 10.1016/j.echo.2017.12.001. Epub 2018 Jan 4.

Authors

Affiliations

¹ Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
² Universitäres Herzzentrum Bad Krozingen, Bad Krozingen, Germany.
³ Department of Cardiology, Bruderholz Hospital, Basel, Switzerland.
⁴ Internal Medicine II, Section of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany.
⁵ Institute of Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, Marburg, Germany.
⁶ Medical Intensive Care Unit, University Hospital Zürich, Zürich, Switzerland.
⁷ Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland. Electronic address: Beat.kaufmann@usb.ch.

PMID: 29306544
DOI: 10.1016/j.echo.2017.12.001

Abstract

Background: Changes in left ventricular (LV) torsion have been related to LV geometry in patients with concomitant long-standing myocardial disease or pulmonary hypertension (PH). We evaluated the effect of acute high altitude-induced isolated PH on LV geometry, volumes, systolic function, and torsional mechanics.

Methods: Twenty-three volunteers were prospectively studied at low altitude and after the second (D3) and third night (D4) at high altitude (4,559 m). LV ejection fraction, multidirectional strains and torsion, LV volumes, sphericity, and eccentricity were derived by speckle-tracking on three-dimensional echocardiographic data sets. Pulmonary pressure was estimated from the transtricuspid pressure gradient (TRPG), LV preload from end-diastolic LV volume, and transmitral over mitral annular E velocity (E/e').

Results: At high altitude, oxygen saturation decreased by 15%-20%, heart rate and cardiac index increased by 15%-20%, and TRPG increased from 21 ± 2 to 37 ± 9 mm Hg (P < .01). LV volumes, preload, ejection fraction, multidirectional strains, and sphericity remained unaffected, but diastolic (1.04 ± 0.07 to 1.09 ± 0.09 on D3/D4, P < .05) and systolic (1.00 ± 0.06 to 1.08 ± 0.1 [D3] and 1.06 ± 0.07 [D4], P < .05) eccentricity slightly increased, indicating mild septal flattening. LV torsion decreased from 2.14 ± 0.85 to 1.34 ± 0.68 (P < .05) and 1.65 ± 0.54 (P = .08) degrees/cm on D3/D4, respectively. Changes in torsion showed a weak inverse relationship to changes in systolic (r = -0.369, P = .013) and diastolic (r = -0.329, P = .032) eccentricity but not to changes in TRPG, heart rate or preload.

Conclusions: High-altitude exposure was associated with mild septal flattening of the LV and reduced ventricular torsion at unchanged global LV function and preload, suggesting a relation between LV geometry and torsional mechanics.

Keywords: 3D echocardiography; Altitude physiology; Left ventricular geometry; Left ventricular torsion.

MeSH terms

Adolescent
Adult
Aged
Altitude*
Diastole
Echocardiography, Doppler / methods*
Echocardiography, Three-Dimensional / methods*
Female
Healthy Volunteers
Heart Ventricles / diagnostic imaging*
Heart Ventricles / physiopathology
Humans
Hypertension, Pulmonary / diagnosis*
Hypertension, Pulmonary / etiology
Hypertension, Pulmonary / physiopathology
Male
Middle Aged
Prospective Studies
Systole
Ventricular Function, Left / physiology*
Young Adult