Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness

  • Chantal Dedobbeleer
  • Alia Hadefi
  • Aurelien Pichon
  • Francisco Villafuerte
  • Robert Naeije
  • Philippe Unger
Original Paper


Hypoxic exposure depresses myocardial contractility in vitro, but has been associated with indices of increased cardiac performance in intact animals and in humans, possibly related to sympathetic nervous system activation. We explored left ventricular (LV) function using speckle tracking echocardiography and sympathetic tone by spectral analysis of heart rate variability (HRV) in recently acclimatized lowlanders versus adapted or maladapted highlanders at high altitude. Twenty-six recently acclimatized lowlanders, 14 healthy highlanders and 12 highlanders with chronic mountain sickness (CMS) were studied. Control measurements at sea level were also obtained in the lowlanders. Altitude exposure in the lowlanders was associated with slightly increased blood pressure, decreased LV volumes and decreased longitudinal strain with a trend to increased prevalence of post-systolic shortening (p = 0.06), whereas the low frequency/high frequency (LF/HF) ratio increased (1.62 ± 0.81 vs. 5.08 ± 4.13, p < 0.05) indicating sympathetic activation. Highlanders had a similarly raised LF/HF ratio, but no alteration in LV deformation. Highlanders with CMS had no change in LV deformation, no significant increase in LF/HF, but decreased global HRV still suggestive of increased sympathetic tone, and lower mitral E/A ratio compared to healthy highlanders. Short-term altitude exposure in lowlanders alters indices of LV systolic function and increases sympathetic nervous system tone. Life-long altitude exposure in highlanders is associated with similar sympathetic hyperactivity, but preserved parameters of LV function, whereas diastolic function may be altered in those with CMS. Altered LV systolic function in recently acclimatized lowlanders may be explained by combined effects of hypoxia and changes in loading conditions.


Hypoxia Altitude Left ventricular strain Myocardial deformation Chronic mountain sickness 



The authors wish to thank the expedition team, V. Faoro and P. Jespers for their helpful contribution and the Instituto de Investigaciones de la Altura Universidad Peruana Cayetano Heredia for the Cerro de Pasco Facilities.

Conflict of interest



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Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  • Chantal Dedobbeleer
    • 1
  • Alia Hadefi
    • 1
  • Aurelien Pichon
    • 2
  • Francisco Villafuerte
    • 3
  • Robert Naeije
    • 4
    • 1
  • Philippe Unger
    • 5
  1. 1.Department of Cardiology, Erasme University HospitalUniversité libre de BruxellesBrusselsBelgium
  2. 2.Cellular and Functional Responses to Hypoxia LaboratoryLaboratory of Excellence Gr-ExBobignyFrance
  3. 3.Laboratorio de Fisiología Comparada, Facultad de Ciencias y FilosofíaUniversidad Peruana Cayetano HerediaLimaPeru
  4. 4.Department of Pathophysiology, Erasme University HospitalUniversité libre de BruxellesBrusselsBelgium
  5. 5.Department of Cardiology, Centre Hospitalier Universitaire Saint PierreUniversité libre de BruxellesBrusselsBelgium

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