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Peer-reviewedCC BY-NC-NDBMC pulmonary medicine

High-altitude exercise stress echocardiography identifies individuals at risk for acute mountain sickness.

  • Yun Xu1,2
  • Sijia Wang1,2
  • Yong Jing1,2
  • Qingfeng Zhang1,2
  • Kai Wang3
  • Yan Deng1,2
  • Jingxue Fan1,2
  • Lixue Yin4,5
  • Yi Wang6,7
7 affiliations
  1. 1University of Electronic Science and Technology of China, Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, chengdu, China.
  2. 2University of Electronic Science and Technology of China, Ultrasound Medicine and Computational Cardiology Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, chengdu, China.
  3. 3University of Electronic Science and Technology of China, Department of Acute Care Surgery, Sichuan Provincial People's Hospital, chengdu, Chine.
  4. 4University of Electronic Science and Technology of China, Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, chengdu, China. [email protected].
  5. 5University of Electronic Science and Technology of China, Ultrasound Medicine and Computational Cardiology Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, chengdu, China. [email protected].
  6. 6University of Electronic Science and Technology of China, Department of Cardiovascular Ultrasound & Noninvasive Cardiology, Sichuan Provincial People's Hospital, chengdu, China. [email protected].
  7. 7University of Electronic Science and Technology of China, Ultrasound Medicine and Computational Cardiology Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, chengdu, China. [email protected].
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Abstract

Background

Early identification of individuals vulnerable to acute mountain sickness (AMS) is clinically challenging. We hypothesized that exercise stress echocardiography (ESE), conducted within 6 h of arrival at 3,600 m following a staged ascent, could reveal distinctive right ventricular (RV) and pulmonary vascular responses predictive of AMS development.Methods

Fifty healthy lowland residents completed a staged bus ascent to 3,600 m and underwent ESE within 6 h of arrival. Key measures included systolic pulmonary artery pressure (SPAP), pulmonary vascular resistance (PVR), tricuspid annular peak systolic velocity (TV s'), RV fractional area change (FAC), inferior vena cava (IVC) diameter, and mean PAP/cardiac output (CO) slope. AMS was assessed the next morning using the Lake Louise Score.Results

Of the participants, 23 (46%) met the criteria for AMS and 27 (54%) did not (non-AMS group). At peak exercise, the AMS group exhibited significantly higher SPAP (54.88 ± 7.89 vs. 46.71 ± 8.48 mmHg, p < 0.001) and PVR (2.24 ± 0.26 vs. 2.03 ± 0.17 WU, p = 0.001), accompanied by greater increases from rest in SPAP (20.42 ± 8.13 vs. 13.21 ± 6.22 mmHg, p = 0.015) and PVR (0.40 ± 0.19 vs. 0.30 ± 0.17 WU, p = 0.010). Conversely, the AMS group demonstrated impaired RV contractile reserve, reflected by smaller ΔTV s' (0.05 ± 0.04 vs. 0.08 ± 0.03 m/s, p = 0.006) and ΔFAC (8.26 ± 3.89 vs. 12.22 ± 5.35%, p = 0.033). IVC diameter was larger in the AMS group both at rest and during peak exercise (p = 0.047 and p = 0.018). A nomogram incorporating peak IVC diameter, ΔPVR, and ΔTV s' predicted AMS with an area under the curve (AUC) of 0.865 and an accuracy of 84.0%.Conclusion

ESE identifies early differences in RV function, IVC dynamics, and pulmonary circulation in individuals susceptible to AMS within hours of arrival at high altitude following staged ascent. A model based on IVC-peak, ΔPVR, and ΔTV s' offers a practical tool for early AMS risk stratification.

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Cite

BibTeXRIS
BibTeX
@article{xu2026highaltitude,
  title = {{High-altitude exercise stress echocardiography identifies individuals at risk for acute mountain sickness.}},
  author = {Yun Xu and Sijia Wang and Yong Jing and Qingfeng Zhang and Kai Wang and Yan Deng and Jingxue Fan and Lixue Yin and Yi Wang},
  journal = {BMC pulmonary medicine},
  year = {2026},
  month = jul,
  doi = {10.1186/s12890-026-04513-7},
  url = {https://europepmc.org/article/MED/42928155},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - High-altitude exercise stress echocardiography identifies individuals at risk for acute mountain sickness.
AU  - Yun Xu
AU  - Sijia Wang
AU  - Yong Jing
AU  - Qingfeng Zhang
AU  - Kai Wang
AU  - Yan Deng
AU  - Jingxue Fan
AU  - Lixue Yin
AU  - Yi Wang
PY  - 2026
DA  - 2026/07/27
JO  - BMC pulmonary medicine
DO  - 10.1186/s12890-026-04513-7
UR  - https://europepmc.org/article/MED/42928155
AB  - Background  Early identification of individuals vulnerable to acute mountain sickness (AMS) is clinically challenging. We hypothesized that exercise stress echocardiography (ESE), conducted within 6 h of arrival at 3,600 m following a staged ascent, could reveal distinctive right ventricular (RV) and pulmonary vascular responses predictive of AMS development.Methods  Fifty healthy lowland residents completed a staged bus ascent to 3,600 m and underwent ESE within 6 h of arrival. Key measures included systolic pulmonary artery pressure (SPAP), pulmonary vascular resistance (PVR), tricuspid annular peak systolic velocity (TV s'), RV fractional area change (FAC), inferior vena cava (IVC) diameter, and mean PAP/cardiac output (CO) slope. AMS was assessed the next morning using the Lake Louise Score.Results  Of the participants, 23 (46%) met the criteria for AMS and 27 (54%) did not (non-AMS group). At peak exercise, the AMS group exhibited significantly higher SPAP (54.88 ± 7.89 vs. 46.71 ± 8.48 mmHg, p < 0.001) and PVR (2.24 ± 0.26 vs. 2.03 ± 0.17 WU, p = 0.001), accompanied by greater increases from rest in SPAP (20.42 ± 8.13 vs. 13.21 ± 6.22 mmHg, p = 0.015) and PVR (0.40 ± 0.19 vs. 0.30 ± 0.17 WU, p = 0.010). Conversely, the AMS group demonstrated impaired RV contractile reserve, reflected by smaller ΔTV s' (0.05 ± 0.04 vs. 0.08 ± 0.03 m/s, p = 0.006) and ΔFAC (8.26 ± 3.89 vs. 12.22 ± 5.35%, p = 0.033). IVC diameter was larger in the AMS group both at rest and during peak exercise (p = 0.047 and p = 0.018). A nomogram incorporating peak IVC diameter, ΔPVR, and ΔTV s' predicted AMS with an area under the curve (AUC) of 0.865 and an accuracy of 84.0%.Conclusion  ESE identifies early differences in RV function, IVC dynamics, and pulmonary circulation in individuals susceptible to AMS within hours of arrival at high altitude following staged ascent. A model based on IVC-peak, ΔPVR, and ΔTV s' offers a practical tool for early AMS risk stratification.
SN  - 1471-2466
ER  -