What does this research mean for the field?

A predictive nomogram combining peak inferior vena cava diameter, change in pulmonary vascular resistance, and change in tricuspid annular peak systolic velocity derived from exercise stress echocardiography predicts acute mountain sickness with an AUC of 0.865. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To assess whether exercise stress echocardiography performed within 6 hours of arrival at 3,600 m can identify right ventricular and pulmonary vascular responses predictive of acute mountain sickness.

July 29, 2026BMC Pulmonary MedicineOpen Access

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

Q: What are the key findings of this study?

A nomogram incorporating peak inferior vena cava diameter, change in pulmonary vascular resistance, and change in tricuspid annular peak systolic velocity predicted acute mountain sickness with an AUC of 0.865 and an accuracy of 84.0%.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Mountain Sickness (AMS) (n=50). Intervention: Exercise stress echocardiography (ESE) parameters (peak IVC diameter, ΔPVR, and ΔTV s′) vs. Non-AMS group. Primary outcome: Prediction of acute mountain sickness (AMS) using a multiparametric nomogram (AUC 0.865, 95% CI 0.760-0.969).

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Key result

Exercise stress echocardiography nomogram predicts acute mountain sickness with ~84% accuracy.

AUC 0.865
95% CI 0.760-0.969
n=50

Why the study?

Early identification of individuals vulnerable to acute mountain sickness is clinically challenging.

Does exercise stress echocardiography predict acute mountain sickness in healthy lowland residents ascending to high altitude?

Comparison

Participants who developed acute mountain sickness vs those who did not

Design

Prospective observational cohort study

Follow-up

The next morning

Authors

YXYan XuSouth China Agricultural University SWS WangNanjing Drum Tower Hospital YJYong JingFourth People's Hospital of Sichuan Province

Discussion

Member takes

Implication

Nomogram may aid early AMS risk stratification after ascent; leaves open prospective validation before clinical use.

Key Points

To assess whether exercise stress echocardiography performed within 6 hours of arrival at 3,600 m can identify right ventricular and pulmonary vascular responses predictive of acute mountain sickness.
Enrolled 50 healthy lowland residents who completed a staged bus ascent to 3,600 m.
Conducted exercise stress echocardiography (ESE) within 6 hours of arrival to measure pulmonary hemodynamics and right ventricular function.
Assessed acute mountain sickness (AMS) the following morning using the Lake Louise Score.
At 3,600 m, 23 of 50 participants (46%) developed AMS, while 27 (54%) did not.
At peak exercise, the AMS group had 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), with larger increases 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).
Contractile reserve was reduced in the AMS group, showing 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); a nomogram combining peak IVC diameter, ΔPVR, and ΔTV s′ predicted AMS with an AUC of 0.865 (95% CI, 0.760–0.969) and 84.0% accuracy.

Study Design

Type

Cohort (n=50)

Blinding

Blinded to participants' AMS status during offline echocardiographic analysis

Multicenter

Structured PICO

Does exercise stress echocardiography predict acute mountain sickness in healthy lowland residents ascending to high altitude?

Population

50 healthy lowland residents (mean age 35 years, 38% female) free of cardiovascular disease who completed a staged ascent to 3,600 meters and underwent exercise stress echocardiography within 6 hours of arrival.

Exposure

Semi-recumbent bicycle exercise stress echocardiography (ESE) conducted within the first 6 hours of arrival at 3,600 meters.

Outcome

Development of acute mountain sickness (AMS) assessed the next morning using the 2018 Lake Louise Score (LLS) questionnaire (defined as a total score ≥3 points, including at least one point for headache).patient reported

Main Result

Effect estimate: AUC 0.865 (95% CI 0.760-0.969)

Exercise stress echocardiography performed within 6 hours of arrival at high altitude identifies distinctive right ventricular and pulmonary vascular responses that accurately predict the development of acute mountain sickness.

Limitations

Modest sample size
Exclusion of subjects without measurable tricuspid regurgitation
Use of non-invasive rather than invasive hemodynamic assessment
Generalizability beyond healthy Han Chinese adults remains uncertain
Small number of AMS subjects precluded severity-stratified and sex-stratified subgroup analyses
Staged ascent protocol may attenuate cardiovascular stress compared with rapid or acute ascent profiles
No formal a priori sample size calculation
Exploratory nature of the field study
Logistical constraints of high-altitude research

Cite This Study

Xu et al. (2026) conducted a cohort in Acute Mountain Sickness (AMS) (n=50). Exercise stress echocardiography (ESE) parameters (peak IVC diameter, ΔPVR, and ΔTV s′) vs. Non-AMS group was evaluated on Prediction of acute mountain sickness (AMS) using a multiparametric nomogram (AUC 0.865, 95% CI 0.760-0.969). A nomogram incorporating peak inferior vena cava diameter, change in pulmonary vascular resistance, and change in tricuspid annular peak systolic velocity predicted acute mountain sickness with an AUC of 0.865 and an accuracy of 84.0%.

synapsesocial.com/papers/6a69a2a3c8da07d9defa655e https://doi.org/10.1186/s12890-026-04513-7

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

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

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider