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Pulmonary Vascular Function and Aerobic Exercise Capacity at Moderate Altitude

FAORO, VITALIE1; DEBOECK, GAEL1,2; VICENZI, MARCO1,2,3; GASTON, ANNE-FLEUR4; SIMAGA, BAMODI1; DOUCENDE, GRÉGORY4; HAPKOVA, ILONA4; ROCA, EMMA5; SUBIRATS, ENRIC5,6; DURAND, FABIENNE4; NAEIJE, ROBERT1

Medicine & Science in Sports & Exercise: October 2017 - Volume 49 - Issue 10 - p 2131–2138
doi: 10.1249/MSS.0000000000001320
Applied Sciences

Purpose There has been suggestion that a greater “pulmonary vascular reserve” defined by a low pulmonary vascular resistance (PVR) and a high lung diffusing capacity (DL) allow for a superior aerobic exercise capacity. How pulmonary vascular reserve might affect exercise capacity at moderate altitude is not known.

Methods Thirty-eight healthy subjects underwent an exercise stress echocardiography of the pulmonary circulation, combined with measurements of DL for nitric oxide (NO) and carbon monoxide (CO) and a cardiopulmonary exercise test at sea level and at an altitude of 2250 m.

Results At rest, moderate altitude decreased arterial oxygen content (CaO2) from 19.1 ± 1.6 to 18.4 ± 1.7 mL·dL−1, P < 0.001, and slightly increased PVR, DLNO, and DLCO. Exercise at moderate altitude was associated with decreases in maximum O2 uptake (V˙O2max), from 51 ± 9 to 43 ± 8 mL·kg−1⋅min−1, P < 0.001, and CaO2 to 16.5 ± 1.7 mL·dL−1, P < 0.001, but no different cardiac output, PVR, and pulmonary vascular distensibility. DLNO was inversely correlated to the ventilatory equivalent of CO2 (E/V˙CO2) at sea level and at moderate altitude. Independent determinants of V˙O2max as determined by a multivariable analysis were the slope of mean pulmonary artery pressure–cardiac output relationship, resting stroke volume, and resting DLNO at sea level as well as at moderate altitude. The magnitude of the decrease in V˙O2max at moderate altitude was independently predicted by more pronounced exercise-induced decrease in CaO2 at moderate altitude.

Conclusion Aerobic exercise capacity is similarly modulated by pulmonary vascular reserve at moderate altitude and at sea level. Decreased aerobic exercise capacity at moderate altitude is mainly explained by exercise-induced decrease in arterial oxygenation.

1Laboratory of Exercise Physiology, Faculty of Motor Sciences, Université Libre de Bruxelles, Brussels, BELGIUM; 2Department of Cardiology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, BELGIUM; 3U.O.C. Cardiovascular Diseases, Fondazione IRCCS Granda Hospital Maggiore Policlinico, Milan, ITALY; 4European Laboratory of Performance Health and Altitude, University of Perpignan, Font-Romeu, FRANCE; 5Faculty of Medicine, University of Girona, Girona, SPAIN; and 6Hospital Transfronterer de Cerdanya, Puigcerdà, SPAIN

Address for correspondence: Vitalie Faoro, M.Sc., Ph.D., Laboratory of Exercise Physiology, Faculty of Motor Science, Université Libre de Bruxelles Route de Lennik 808-CP 640, 1070, Brussels, Belgium; E-mail: vfaoro@ulb.ac.be.

Submitted for publication November 2016.

Accepted for publication April 2017.

© 2017 American College of Sports Medicine