Extract
In the present issue of theEuropean Respiratory Journal, Soriaet al.[1] report on a meta-analysis of echocardiographic estimates of systolic pulmonary artery pressure (sPAP) in 287 patients (nine studies) with chronic mountain sickness (CMS) at rest and in 142 of them (five studies) also at exercise. The results are surprising. Mean pulmonary artery pressure (mPAP), here recalculated as 0.6×sPAP+2 mmHg [2], was on average 18 mmHg (95% CI 16–20 mmHg) at rest and 31 mmHg (95% CI 29–33 mmHg) during exercise, suggesting no pulmonary hypertension (PH) at rest but mild PH during exercise. The same authors had previously reported on a similar meta-analysis in a larger number of 834 healthy high altitude dwellers at rest, showing a mPAP of 18 mmHg and a maximum of 24 mmHg, compared to 13 mmHg and a maximum of 20 mmHg, respectively, in sea level controls [3]. On the basis of these data altogether, Soriaet al.[1] conclude that high altitude dwellers with or without CMS have no PH at rest, but CMS patients commonly present with exercise-induced PH, which may be of symptomatic and of prognostic relevance. This is provocative, as altitude is listed as “hypoxia without lung disease” in the updated classification of PH, and experts remain unconvinced about the notion of exercise-induced PH [4].
Abstract
Pulmonary hypertension at high altitude is uncommonhttp://bit.ly/2JxD2Q3
Footnotes
Conflict of interest: R. Naeije has nothing to disclose.
- ReceivedMay 16, 2019.
- AcceptedMay 16, 2019.
- Copyright ©ERS 2019