Influence of altitude exposure on coronary flow reserve.

BACKGROUND: Although no data exist on the effect of altitude exposure on coronary flow reserve (CFR), patients with coronary artery disease (CAD) are advised not to exceed moderate altitudes of approximately 2500 m above sea level. We studied the influence of altitude on myocardial blood flow (MBF) in controls and CAD patients. METHODS AND RESULTS: In 10 healthy controls and 8 patients with CAD, MBF was measured by positron emission tomography and 15O-labeled water at rest, during adenosine stress, and after supine bicycle exercise. This protocol was repeated during inhalation of a hypoxic gas mixture corresponding to an altitude of 4500 m (controls) and 2500 m (CAD). Workload was targeted to comparable heart rate-blood pressure products at normoxia and hypoxia. Resting MBF increased significantly in controls at 4500 m (+24%, P<0.01) and in CAD patients at 2500 m (+24%, P<0.05). Altitude had no influence on adenosine-induced hyperemia and CFR. Exercise-induced hyperemia increased significantly in controls (+38%, P<0.01) at 4500 m (despite a reduction in workload, -28%, P<0.0001) but not in CAD patients at 2500 m (moderate decrease in workload, -11%, P<0.05). Exercise-induced reserve was preserved in controls (+10%, P=NS) but decreased in CAD patients (-18%, P<0.005). CONCLUSIONS: At 2500 m altitude, there is a significant decrease in exercise-induced reserve in CAD patients, indicating that compensatory mechanisms might be exhausted even at moderate altitudes, whereas healthy controls have preserved reserve up to 4500 m. Thus, patients with CAD and impaired CFR should be cautious when performing physical exercise even at moderate altitude.

Gender differences in workload effect on coordination between breathing and cycling.

PURPOSE: To investigate the gender differences in the effect of increasing workload level and thus of an increasing metabolic drive to ventilation on the degree of coordination between breathing and cycling rhythms. METHODS: Twenty-one men and 21 women cycled on an electromagnetically braked ergometer while breathing through a pneumotachograph at workloads corresponding to 55, 75, and 95% of V0(2peak) (WL1, WL2, and WL3). Leg movements, respiratory parameters, and heart rate were continuously recorded. The degree of coordination (%coord) was quantified as the percentage of breaths starting during the same phase of leg movement. RESULTS: In men, %coord increased with increasing exercise intensity (WL1: mean +/- SE = 18.8 +/- 2.6%, WL2: 30.9 +/- 4.9%, WL3: 40.9 +/- 5.6%), whereas in women exercise intensity had no influence on %coord (WL1: 25.0 +/- 5.0%, WL2: 29.7 +/- 5.1, WL3: 31.7 +/- 4.7%). There were no gender differences in breathing pattern during high metabolic demands. A major effect on %coord came from the regularity of the breathing rhythm, whereas cycling frequency, fitness level, or cycling experience exerted no influence. CONCLUSIONS: The present study demonstrates that the effect of exercise intensity on the occurrence of coordination between breathing and cycling rhythms differs between men and women.

Influence of hypoxia on coordination between breathing and cycling rhythms in women.

To investigate interactions between neural (movement) and chemical (hypoxia) respiratory drives during exercise, we analyzed coordination between breathing and cycling rhythms in normoxia (N) and hypoxia (H, 14.5% O(2)). Twenty women [28 (1) years old] cycled for 6 min at three workloads (55%, 75%, and 95% peak oxygen consumption, VO(2peak); WL1, WL2, and WL3) in N and H. Leg movements, respiratory parameters, peripheral oxygen saturation, and heart rate were continuously recorded. The degree of coordination (%COORD) was quantified as the percentage of breaths starting during the same phase of leg movement. Ventilatory response to isocapnic hypoxia (VRH) was assessed at rest during an exposure to an end-tidal PO(2) of 50 mmHg. There were no differences in %COORD between N and H at any of the three workloads, but %COORD increased significantly from WL1 to WL3 in H. There was no correlation between VRH and %COORD. In conclusion, chemical and neural respiratory drives did not competitively interact: coordination between breathing and cycling rhythms was not reduced during H and did not depend on individual VRH.

Characteristics of the ventilatory response in subjects susceptible to high altitude pulmonary edema during acute and prolonged hypoxia.

The present study compares the changes in ventilation in response to sustained hypobaric hypoxia and acute normobaric hypoxia between subjects susceptible to high altitude pulmonary edema (HAPE-S) and control subjects (C-S). Seven HAPE-S and five C-S were exposed to simulated high altitude of 4000 m for 23 h in a hypobaric chamber. Resting minute ventilation (V(E)), tidal volume (V(T)), and respiratory frequency (f(R)), as well as the end-tidal partial pressures of oxygen (P(ET(O2))) and carbon dioxide (P(ET(CO2))) were measured in all subjects sitting in a standardized position. Six measurement periods were recorded: ZH1 at 450 m at Zurich level, HA1 on attaining 3600 m altitude, HA2 after 20 min at 4000 m, HA3 after 21 h and HA4 after 23 h at 4000 m altitude, and ZH2 immediately after recompression to Zurich level. At ZH1 and HA3, the measurements were first done in lying, then in sitting, and afterwards in standing. Peripheral arterial oxygen saturation (Sa(O2)) was continuously recorded. All respiratory parameters were also measured during exercise lasting 30 min, the work load being 50% of maximal oxygen consumption (V(O2max)) at Zurich level and 26% of the Zurich V(O2max) at 4000 m. V(E), P(ET(O2)) and P(ET(CO2)) did not significantly differ between HAPE-S and C-S at rest and during exercise periods at Zurich level and at high altitude. However, Sa(O2) was significantly lower in HAPE-S than in C-S at rest and during exercise at 4000 m. Breathing through the mouthpiece during ventilation measurements increased significantly the Sa(O2) in HAPE-S in posture tests at HA3. This effect was most pronounced in the supine posture, in which HAPE-S had the lowest Sa(O2) values. These data provide evidence that (1) gas exchange might be impaired on the level of ventilation-perfusion mismatch or due to diffusion limitation in HAPE-S during the first 23 h of exposure to a simulated altitude of 4000 m, and (2) contrary to C-S, the Sa(O2) in HAPE-S is significantly affected by body position and by mouthpiece breathing.

Changes of respiratory sinus arrhythmia during the menstrual cycle depend on average heart rate.

To evaluate the complex time course of changes in respiratory sinus arrhythmia (RSA) during the menstrual cycle, daily beat-to-beat morning recordings of heart rate (HR) were carried out in 26 healthy female subjects (age 20-29 years) during two menstrual cycles. For determination of fast, vagally mediated variations of HR we used a robust time-domain measure of RSA (logRSA). We found pronounced changes in HR during the menstrual cycle with a minimum in the early follicular phase and a maximum in the late luteal phase. There were large differences between individuals in the fluctuations of logRSA during the menstrual cycle that were related to average HR: subjects with a low HR exhibited higher values of logRSA in the luteal compared to the follicular phase, whereas the trend was reversed in subjects with a high HR. The difference of extreme points of logRSA fluctuations (early follicular and mid luteal phase) was correlated to average HR (r=-0.64, P < 0.001). We conclude that different patterns of RSA fluctuations occur depending on the level of average HR.