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Published ahead of print on October 14, 2004, doi:10.1164/rccm.200406-707OC

Am. J. Respir. Crit. Care Med., Volume 171, Number 1, January 2005, 83-87

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Submitted on June 4, 2004
Accepted on October 8, 2004

Pulmonary Blood Flow Heterogeneity during Hypoxia and High Altitude Pulmonary Edema

Susan R Hopkins1*, Joy Garg2, Divya S Bolar3, Jamal Balouch2, and David L Levin3

1 Department of Medicine, Division of Physiology, University of California at San Diego, La Jolla, CA, USA; Department of Radiology, University of California at San Diego, La Jolla, CA, USA, 2 Department of Medicine, Division of Physiology, University of California at San Diego, La Jolla, CA, USA, 3 Department of Radiology, University of California at San Diego, La Jolla, CA, USA

* To whom correspondence should be addressed. E-mail: shopkins{at}ucsd.edu.

Uneven hypoxic pulmonary vasoconstriction has been proposed to expose parts of the pulmonary capillary bed to high pressure and vascular injury in high altitude pulmonary edema. We hypothesized that subjects with a history of high altitude pulmonary edema would demonstrate increased heterogeneity of pulmonary blood flow during hypoxia. A functional magnetic resonance imaging technique (arterial spin labeling), was used to quantify spatial pulmonary blood flow heterogeneity in 3 subject groups: 1) Susceptible (n=5), history of physician documented high altitude pulmonary edema; 2) Resistant (n=6), repeated high altitude exposure without illness, 3) Unselected (n=6), minimal history of altitude exposure. Data were collected in normoxia and after 5, 10, 20 and 30 minutes of normobaric hypoxia (FIO2= 0.125). Relative dispersion (standard deviation/mean) of the signal intensity was used as an index of perfusion heterogeneity. Oxygen saturation was not different between groups during hypoxia. Relative dispersion was not different between groups (0.94±0.05 Susceptible, 0.94±0.05 Resistant, 0.87±0.06 Unselected, means ± SEM) during normoxia, but it was increased by hypoxia in Susceptible (to 1.10±0.05 after 30 min, p<0.0001) but not in Resistant (0.91±0.05) or Unselected subjects (0.87±0.05). Susceptible individuals have increased pulmonary blood flow heterogeneity in acute hypoxia, consistent with uneven hypoxic pulmonary vasoconstriction.
Key words: Magnetic resonance imaging, pulmonary circulation, hypoxic pulmonary vasoconstriction




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