Risk Factors and Outcomes of HPH in High-Altitude Residents via echocardiographic evaluation

Risk Factors and Outcomes of HPH in High-Altitude Residents via echocardiographic evaluation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk Factors and Outcomes of HPH in High-Altitude Residents via echocardiographic evaluation Shunjun Wang, Laishun Yu, Luyang Huang, Xi Liu, Fanyan Luo, Weixing Wang, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6055115/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background: Over 80 million people reside above 2,500 meters, where hypobaric hypoxia elevates the risk of hypoxic pulmonary hypertension (HPH). In Qinghai, China (>3,000 m), over 5 million face a high HPH burden amid scarce medical resources. Objective: To assess risk factors and clinical correlates of HPH severity and mortality in high-altitude residents using echocardiography. Methods: This retrospective study included 627 patients diagnosed with HPH (PASP ≥50 mmHg) via echocardiography at a tertiary hospital in Qinghai Province, China, from January 2018 to December 2022. Patients were categorized into moderate (50 ≤ PASP < 70 mmHg) and severe (PASP ≥70 mmHg) HPH groups. Clinical, biochemical, and echocardiographic data were collected, with mortality assessed via telephone follow-up after at least one year. Logistic regression identified factors associated with severe HPH, and Cox regression determined mortality predictors. Results: Of the 627 patients, 360 (57.4%) had moderate HPH and 267 (42.6%) had severe HPH. The severe HPH group exhibited lower albumin (33.50 ± 5.54 g/L vs. 35.45 ± 6.65 g/L, p < 0.001) and higher APTT (34.04 ± 7.48 s vs. 31.44 ± 6.91 s, p < 0.001), LPa (142.27 ± 126.64 mg/L vs. 110.67 ± 101.01 mg/L, p = 0.001), and rates of heart failure, cyanosis, and right ventricular hypertrophy (all p < 0.05). Logistic regression identified APTT (OR = 1.050, 95% CI: 1.014–1.087, p = 0.007), LPa (OR = 1.002, 95% CI: 1.001–1.004, p = 0.003), cyanosis (OR = 1.814, 95% CI: 1.235–2.663, p = 0.002), and right ventricular hypertrophy (OR = 3.501, 95% CI: 1.631–7.514, p = 0.001) as factors associated with severe HPH. Multivariate Cox regression identified LPa (HR = 3.461, 95% CI: 2.021–5.928, p < 0.001), atrial fibrillation (HR = 2.534, 95% CI: 1.365–4.705, p = 0.003), heart failure (HR = 2.316, 95% CI: 1.134–4.730, p = 0.021), and alcohol consumption (HR = 3.230, 95% CI: 1.277–8.171, p = 0.013) as mortality predictors. Conclusion: In high-altitude Qinghai residents, APTT, LPa, cyanosis, and right ventricular hypertrophy drive severe HPH, while LPa, atrial fibrillation, heart failure, and alcohol use predict mortality. Monitoring APTT and LPa may aid early detection, and managing modifiable factors like alcohol and atrial fibrillation could lower mortality in resource-limited settings. High-altitude Echocardiography Hypoxic pulmonary hypertension (HPH) All-cause mortality Risk factors Figures Figure 1 Research Significance This study identifies risk factors and clinical correlates of severe HPH in high-altitude residents, offering insights into HPH pathogenesis. Beyond advancing understanding, these findings hold potential implications for prevention and management in high-altitude regions. The association of LPa, APTT, cyanosis, and right ventricular hypertrophy with HPH severity, alongside mortality predictors like LPa, atrial fibrillation, heart failure, and alcohol consumption, suggests actionable targets. Routine screening for elevated LPa and APTT could facilitate early detection, while managing modifiable factors such as alcohol consumption and atrial fibrillation may mitigate disease progression and mortality, guiding strategies to reduce HPH burden where resources are scarce. Introduction Globally, more than 80 million people permanently reside above 2,500 meters, with significant populations in South America (e.g., Aymara and Quechua), Central Asia (e.g., Tibetan and Sherpa), and East Africa (e.g., Ethiopian highlanders), where hypobaric hypoxia—reducing inspiratory oxygen partial pressure to 74% of sea-level values—poses a persistent physiological challenge [ 1 ] . In Qinghai Province, China, with an average elevation exceeding 3,000 meters, over 5 million individuals live between 3,000 and 5,000 meters, increasing the prevalence of HPH, a subtype of PH driven by chronic low oxygen levels [ 2 , 3 ] . This high-altitude context presents unique public health challenges due to limited medical resources and sustained environmental stress. The adaptability to altitude hypoxia varies significantly among different populations, depending on the length of exposure. This exposure can be classified as chronic, acute, or intermittent hypoxia [ 4 ] . HPH, a subtype of pulmonary hypertension(PH) caused by lung disease or hypoxia, has become a major public health concern in mountainous areas due to prolonged exposure to low oxygen levels [ 5 ] . PH affects approximately 1% of the global population, with the prevalence rising to 10% in people over 65 years of age [ 6 ] . HPH is often accompanied by other diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and hypoxic pulmonary heart disease, complicating its diagnosis and management [ 7 ] . Clinical symptoms of HPH include progressive exercise dyspnea, right heart failure, and premature death [ 3 ] . Changes in the adaptive response to hypoxia and the development of HPH are currently thought to be linked to genetic, environmental, or other diseases [ 3 , 8 ] . The current diagnostic standard for PH is right heart catheterization (RHC) to measure pulmonary systolic blood pressure (PASP) [ 9 ] . However, due to the invasive nature and high cost of RHC, echocardiography has become a widely used, non-invasive method for assessing PH, especially in high-altitude areas [ 8 ] . Doppler echocardiography has proven to be a reliable method for evaluating pulmonary artery pressure [ 10 ] . Recent studies have shown that exposure to hypoxia can trigger various metabolic reactions, including changes in lipid metabolism, which are implicated in the development of high-altitude PH [ 11 ] . This study aims to explore the factors that promote the progression of PH in high-altitude residents and the impact of these risk factors on the survival rate of patients with HPH. Methods Research Design This single-center retrospective study analyzed clinical data from Qinghai Provincial People’s Hospital (Qinghai, China) between January 2018 and December 2022. It adhered to the Declaration of Helsinki, with informed consent obtained via telephone follow-up [ 12 ] . The protocol was approved by the Ethics Committee of Qinghai Provincial People’s Hospital (2022-55). Research Population We enrolled 627 patients diagnosed with HPH (PASP ≥ 50 mmHg) via echocardiography. Patients were categorized based solely on PASP into moderate HPH (50 ≤ PASP < 70 mmHg) and severe HPH (PASP ≥ 70 mmHg) groups [ 13 , 14 ] . Exclusion criteria were: (1) age 80 years; (2) history of cardiac surgery; (3) presence of malignant tumors; (4) severe systemic diseases affecting major organs (e.g., liver, kidney, heart, brain, lung) or endocrine systems, unrelated to PH; (5) HIV infection; (6) liver or kidney failure; (7) pregnancy or lactation; (8) congenital heart disease or valvular disease; (9) incomplete clinical data. The study design is depicted in Fig. 1 . Clinical Data Collection Data were collected using Haitai Software 3.0 from medical records, including age, sex, ethnicity, body mass index (BMI), smoking, alcohol consumption, COPD, diabetes, exertional dyspnea, cyanosis, atrial fibrillation, NYHA class, hemoglobin (HB), hematocrit (HCT), C-reactive protein (CRP), albumin, creatinine, urea, B-type natriuretic peptide (BNP), prothrombin time (PT), activated partial thromboplastin time (APTT), lipoprotein(a) (LPa), and LDL/HDL ratio. Cyanosis was defined as visible bluish discoloration of the skin, lips, or nail beds, assessed clinically without consistent blood gas confirmation. Mortality data were obtained through telephone follow-up by trained staff at least 1 year post-admission, querying family members or caregivers, not sourced from community centers. Echocardiography Echocardiography was performed using the Philips EPIQ7 system, following the guidelines of the American Society of Echocardiography [ 15 ] . All enrolled patients underwent Doppler echocardiography, as described in Doppler Echocardiography – Knowledge and References by Taylor & Francis [ 16 ] . Continuous Doppler was used to measure the peak velocity of the tricuspid regurgitation jet, while pulsed Doppler assessed the peak velocity curves of pulmonary artery blood flow and the right ventricular outflow tract. In the absence of right ventricular outflow tract obstruction, right ventricular systolic pressure reflects PASP. PASP was estimated by combining the peak tricuspid regurgitation velocity with right atrial pressure, which was determined from the inferior vena cava diameter and its respiratory changes. If tricuspid regurgitation velocity was difficult to obtain, alternative measures such as early diastolic pulmonary regurgitation velocity or right ventricular outflow Doppler acceleration time were considered [ 17 ] . Data on PH diagnosis and treatment were evaluated against the 2022 ESC/ERS Guidelines [ 9 ] . Certified cardiologists conducted the echocardiography, adhering to both ASE guidelines and the heart color Doppler ultrasound protocols of Fuwai Hospital, ensuring standardized imaging and interpretation to reduce variability and improve accuracy. Statistical Analysis Data were analyzed using SPSS 26.0. Continuous variables (mean ± SD) were compared using t-tests (equal variances assumed unless Levine’s test indicated otherwise), and categorical variables (frequencies, %) via chi-square tests. Logistic regression was used to identify factors associated with severe HPH due to its ability to model binary outcomes and estimate odds ratios (ORs). Cox proportional hazards regression was selected to evaluate mortality predictors, analyzing time-to-event data and providing hazard ratios (HRs). Multivariate Cox models adjusted for LPa, LDL/HDL ratio, atrial fibrillation, right ventricular hypertrophy, heart failure, smoking, and alcohol consumption using a forced entry approach. *p*<0.05 indicated significance. Results 1. General information of the research patients Between January 2018 and June 2020, this retrospective study collected and analyzed the medical records of 627 patients who were hospitalized and assessed for HPH. According to the results of echocardiography, PASP is estimated to be less than or equal to 70mmHg, and PASP greater than 50mmHg is moderate PASP group, and PASP greater than 70mmHg is defined as severe PASP group. Among them, there were 360 patients (57.4%) with 50≤PASP<70mmHg and 267 patients (42.6%) with PASP≥70mmHg. There were 161 patients under 60 years old (25.7%) and 466 patients ≥60 years old (74.3%). There were 299 (47.7%) female patients and 328 (52.3%) male patients. The patients included in the study were mainly Han, Hui and Tibetan. Smoking and alcohol consumption accounted for less than 20 percent of the study population. There were 206 people (32.9%) with BMI≥24 and 69 people (11%) with diabetes. Of the total study population, 267 (42.6%) had COPD and 329 (52.5%) had exertional dyspnea and 405 (64.6%) had significant cyanosis. This study also included basic data such as atrial fibrillation and NYHA cardiac function, as shown in Table 1. Table 1 Baseline data table Group Number（%） Age ＜60 161（25.7） ≥60 466（74.3） Sex female 299（47.7） male 328（52.3） Ethnic han 392（62.5） Tibetan 66（10.5） Hui 122（19.5） others 47（7.5） Smoking no 514（82.0） yes 113（18.0） Drinking no 559（89.2） yes 68（10.8） Diabetes no 558（89.0） yes 69（11.0） BMI < 24 421（67.1） ≧24 206（32.9） COPD no 360（57.4） yes 267（42.6） Exertional dyspnea no 298（47.5） yes 329（52.5） Cyanosis no 222（35.4） yes 405（64.6） Atrial fibrillation no 541（86.3） yes 86（13.7） PASP 50-70mmHg 360（57.4） ≧70 mmHg 267（42.6） NYHA 1 216（34.4） 2 80（12.8） 3 240（38.3） 4 91（14.5） 2. Relationship between Clinical Parameters and PASP in HPH Patients This retrospective study compared clinical, hematological, coagulation, and echocardiographic parameters between high-altitude residents with hypoxic HPH categorized by PASP into moderate (50 ≤ PASP < 70 mmHg, n=360) and severe (PASP ≥70 mmHg, n=267) groups, as assessed by echocardiography. Patients with severe HPH exhibited significantly lower albumin levels (33.50 ± 5.54 g/L vs. 35.45 ± 6.65 g/L, p < 0.001), PT; 14.42 ± 4.99 s vs. 13.56 ± 3.46 s, p = 0.011, APTT; 34.04 ± 7.48 s vs. 31.44 ± 6.91 s, p < 0.001, D-dimer (0.81 ± 0.62 mg/L vs. 0.58 ± 0.40 mg/L, p < 0.001), LPa; 142.27 ± 126.64 mg/L vs. 110.67 ± 101.01 mg/L, p = 0.001, and LDL/HDL ratio (2.50 ± 0.98 vs. 2.33 ± 0.86, p = 0.022) compared to the moderate HPH group (Table 2). Hemoglobin (Hb) levels were higher in the severe HPH group (165.21 ± 101.00 g/L vs. 152.97 ± 36.46 g/L, p = 0.059), potentially reflecting high-altitude polycythemia, which may increase blood viscosity and contribute to elevated pulmonary artery pressure. Additionally, the severe HPH group showed a larger right atrial diameter (47.67 ± 8.90 mm vs. 41.30 ± 7.75 mm, p < 0.001), indicating more pronounced right heart remodeling. Table 2. Clinical and Imaging Parameters in HPH Patients 50＜PASP＜70 PASP≥70 t/F p HB(g/L) 152.97±36.46 165.21±101.00 -1.892 0.059 Mononuclear (%) 8.13±2.75 8.42±2.79 -1.313 0.190 HCT(%) 49.49±32.17 49.59±13.15 -0.051 0.959 CRP(mg/L) 2.33±4.93 2.59±4.22 -0.677 0.498 Albumin (g/L) 35.45±6.65 33.50±5.54 3.881 0.0001* Creatinine (µmol/L) 78.82±47.15 79.32±40.05 -0.141 0.888 Carbamide (µmol/L) 7.48±4.63 10.72±35.21 -1.726 0.085 BNP(ng/L) 610.63±914.16 602.67±657.70 0.127 0.899 PT 13.56±3.46 14.42±4.99 -2.536 0.011* APTT 31.44±6.91 34.04±7.48 -4.489 0.0001* D-Dimer (mg/L) 0.58±0.40 0.81±0.62 -5.685 0.0001* LPa (mg/L) 110.67±101.01 142.27±126.64 -3.360 0.001* LDL/HDL 2.33±.86 2.50±.98 -2.302 0.022* right atrial diameter 41.30±7.75 47.67±8.90 -9.556 0.0001* LAVI(mL/m 2 ) 29.02±7.09 27.99±5.95 1.924 0.055 *Note: *p*<0.05 indicates statistical significance.* 2.1 Arterial Blood Gas Analysis The arterial blood gas analysis revealed no statistically significant differences between the moderate HPH group (50 < PASP < 70 mmHg) and the severe HPH group (PASP ≥ 70 mmHg) in terms of key parameters. Specifically, the partial pressure of oxygen (PO₂) was 74.30 ± 19.44 mmHg in the moderate group compared to 73.51 ± 19.39 mmHg in the severe group (p = 0.618). Similarly, the partial pressure of carbon dioxide (PCO₂) was 34.92 ± 7.04 mmHg versus 34.16 ± 6.09 mmHg (p = 0.159), and oxygen saturation (SO₂) was 92.61 ± 5.18% versus 92.10 ± 5.29% (p = 0.226). Additionally, lactate levels (LAC) were comparable between the two groups, with values of 2.02 ± 1.45 mmol/L in the moderate group and 1.91 ± 0.81 mmol/L in the severe group (p = 0.244). These findings suggest that arterial blood gas parameters do not significantly differ based on the severity of HPH in this cohort (Table 2.1). Table 2.1: Comparison of Arterial Blood Gas Parameters 50＜PASP＜70 PASP≥70 t/F p PO 2 (mmHg) 74.30±19.44 73.51±19.39 0.498 0.618 PCO 2 (mmHg) 34.92±7.04 34.16±6.09 1.410 0.159 SO 2 (%) 92.61±5.18 92.10±5.29 1.211 0.226 LAC (mmol/L) 2.02±1.45 1.91±0.81 1.167 0.244 3. Relationship between pulmonary artery pressure and general clinical data and clinical symptoms According to the experimental results, the severity of PASP in patients with HPH was significantly correlated with right ventricular hypertrophy, cyanosis, heart failure, and NYHA cardiac function grade (p<0.05), with the boundary of pulmonary artery pressure estimated by echocardiographic at 70mmHg. The results of this experiment showed that there was no significant correlation between the severity of HPH and age, sex, ethnicity, BMI, smoking, drinking and diabetes (p>0.05). Whether patients suffer from atrial fibrillation and COPD may be correlated with the severity of HPH (p=0.092, p=0.074), and the sample size needs to be further expanded for verification (Table 3). Table 3: Association Between Clinical Indicators and HPH Severity Group 50-70 (n=360) ≥70 (n=267) χ² p Age <60 / ≥60 96 / 264 65 / 202 0.433 0.51 Sex Female / Male 174 / 186 125 / 142 0.141 0.707 Ethnicity Han / Tibetan / Hui / Others 223 / 36 / 72 / 29 169 / 30 / 50 / 18 0.748 0.862 BMI <24 / ≥24 249 / 111 172 / 95 1.566 0.211 Smoking No / Yes 301 / 59 213 / 54 1.527 0.217 Drinking No / Yes 317 / 43 242 / 25 1.056 0.304 COPD No / Yes 217 / 143 143 / 124 2.831 0.092 Diabetes No / Yes 321 / 39 237 / 30 0.025 0.873 NYHA 1 / 2 / 3 / 4 140 / 47 / 128 / 45 76 / 33 / 112 / 46 8.892 0.031* Heart Failure No / Yes 284 / 76 177 / 90 12.497 0.0001* Cyanosis No / Yes 152 / 208 70 / 197 17.171 0.0001* Atrial Fibrillation No / Yes 303 / 57 238 / 29 3.202 0.074 Right Ventricular Hypertrophy No / Yes 350 / 10 235 / 32 20.794 0.0001* Exertional Dyspnea No / Yes 166 / 194 132 / 135 0.68 0.409 *Note: *p*<0.05 indicates statistical significance.* 4. Multivariate Logistic regression analysis results of patients with moderate to severe HPH A multivariate logistic regression analysis was performed to identify risk factors associated with the progression of HPH from moderate to severe, using variables that showed statistically significant differences between the two groups. The results indicated that laboratory markers APTT (OR = 1.050, 95% CI: 1.014–1.087, p = 0.007) and LPa (OR = 1.002, 95% CI: 1.001–1.004, p = 0.003) were significant risk factors for the progression of HPH to severe. Additionally, clinical factors such as cyanosis (OR = 1.814, 95% CI: 1.235–2.663, p = 0.002) and right ventricular hypertrophy (OR = 3.501, 95% CI: 1.631–7.514, p = 0.001) were strongly associated with an increased risk of progression to severe HPH. In contrast, other variables, including PT, LDL/HDL, NYHA classification, heart failure, atrial fibrillation, and albumin, were not significantly associated with the progression of HPH to severe (p > 0.05). (Table 4) Table 4. Multivariate Logistic regression analysis of risk factors for moderate-to-severe HPH *Note: *p*<0.05 indicates statistical significance. * Forest Plot of Logistic Regression Results for Severe HPH Risk Factors. Caption: Visualizes ORs and 95% CIs from Table 4. 5. Factors Associated with Mortality in High-Altitude Residents with HPH This study included high-altitude residents diagnosed with HPH via echocardiography (PASP ≥50 mmHg) at a tertiary hospital in Qinghai, China, with continuous follow-up for at least one year to assess mortality. Univariate Cox regression analysis identified LPa (HR = 2.946, 95% CI: 1.759–4.935, p < 0.001), atrial fibrillation (HR = 2.120, 95% CI: 1.162–3.867, p = 0.014), and alcohol consumption (HR = 2.218, 95% CI: 1.200–4.101, p = 0.011) as significant predictors of mortality (Table 5). Multivariate Cox regression, adjusted for LPa, LDL/HDL ratio, atrial fibrillation, right ventricular hypertrophy, heart failure, smoking, and alcohol consumption, further confirmed LPa (HR = 3.461, 95% CI: 2.021–5.928, p < 0.001), atrial fibrillation (HR = 2.534, 95% CI: 1.365–4.705, p = 0.003), heart failure (HR = 2.316, 95% CI: 1.134–4.730, p = 0.021), and alcohol consumption (HR = 3.230, 95% CI: 1.277–8.171, p = 0.013) as independent risk factors for mortality. These findings highlight the prognostic significance of LPa, atrial fibrillation, heart failure, and alcohol consumption in HPH patients, underscoring the need for targeted risk management strategies in this population. Table 5. COX regression analysis of patients with moderate to severe HPH Univeriate analysis Multiveriate analysis p HR 95%CI p HR 95%CI LPa 0.001* 2.946 1.759-4.935 0.001* 3.461 2.021-5.928 LDL/HDL 0.276 1.325 0.798-2.201 0.414 1.238 0.742-2.066 Atrial fibrillation 0.014* 2.120 1.162-3.867 0.003* 2.534 1.365-4.705 Right ventricular hypertrophy 0.185 1.866 0.742-4.690 0.179 1.917 0.743-4.950 Heart failure 0.060 1.973 0.971-4.009 0.021* 2.316 1.134-4.730 smoking 0.087 1.648 0.930-2.921 0.538 0.766 0.328-1.789 drinking 0.011* 2.218 1.200-4.101 0.013* 3.230 1.277-8.171 *Note: *p*<0.05 indicates statistical significance.* Discussion This study employed Doppler echocardiography to estimate PASP in a cohort of 627 high-altitude residents in Qinghai, China, where chronic hypoxia at elevations exceeding 3,000 meters significantly increases the risk of HPH. Echocardiography provides a practical, non-invasive alternative to RHC in resource-limited high-altitude settings; however, its limitations warrant careful consideration. Echocardiography may overestimate PASP in the presence of high-altitude polycythemia, altered thoracic anatomy, or elevated cardiac output, potentially leading to false-positive diagnoses of PH [ 18 , 19 ] . This overestimation can complicate clinical decision-making, particularly in high-altitude settings where even mild PASP elevations may be misinterpreted as pathological, a challenge highlighted by Jankowich et al., who note the lack of clear guidelines for managing such cases [ 18 , 19 ] . Compared to RHC—the gold standard, which directly measures mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance—echocardiography’s sensitivity and specificity for PH diagnosis range from 85–88% and 63–87%, respectively [ 21 ] . In high-altitude populations, where chronic hypoxia alters hemodynamics, these discrepancies may be amplified, particularly due to the lack of validation studies specifically addressing echocardiography’s accuracy in such contexts [ 4 ] . Arterial blood gas analysis in our cohort revealed a PO2 of approximately 74 mmHg (Table 2.1 ), confirming chronic hypoxia consistent with expected declines at this altitude (~ 12 mmHg per 1,600 m) [ 22 ] . However, the absence of significant differences in PO 2 (p = 0.618) and SO 2 (p = 0.226) between the moderate (50 ≤ PASP 3,000 m) in Qinghai, where compensatory mechanisms such as polycythemia (Hb 165.21 ± 101.00 g/L in severe HPH vs. 152.97 ± 36.46 g/L in moderate HPH, p = 0.059, Table 2 ) may mitigate oxygenation differences, potentially masking severity-specific variations in oxygenation. Logistic regression analysis identified APTT (OR = 1.050, 95% CI: 1.014–1.087, p = 0.007), LPa (OR = 1.002, 95% CI: 1.001–1.004, p = 0.003), cyanosis (OR = 1.814, 95% CI: 1.235–2.663, p = 0.002), and right ventricular hypertrophy (OR = 3.501, 95% CI: 1.631–7.514, p = 0.001) as independent factors associated with severe HPH (Table 4 ). Elevated APTT in the severe HPH group (34.04 ± 7.48 s vs. 31.44 ± 6.91 s, p < 0.001, Table 2 ) suggests a coagulopathy, potentially driven by hypoxia-induced endothelial dysfunction or microthrombosis, both of which contribute to increased pulmonary vascular resistance [ 23 ] . This observation is consistent with prior evidence that chronic hypoxia disrupts hemostatic balance, although the precise mechanisms underlying coagulopathy in HPH remain underexplored [ 24 ] . Notably, D-dimer levels were also significantly elevated in the severe HPH group (0.81 ± 0.62 mg/L vs. 0.58 ± 0.40 mg/L, p < 0.001, Table 2 ), reinforcing the presence of a pro-thrombotic state in advanced HPH. These coagulation abnormalities highlight a potential therapeutic avenue, as anticoagulation or anti-thrombotic strategies may mitigate disease severity, though clinical trials are needed to establish their efficacy in this population. The association of LPa with severe HPH is particularly intriguing. LPa, a pro-atherogenic and pro-thrombotic lipoprotein, was significantly elevated in the severe HPH group (142.27 ± 126.64 mg/L vs. 110.67 ± 101.01 mg/L, p = 0.001, Table 2 ). Its role in HPH may involve hypoxia-driven alterations in lipid metabolism, promoting endothelial injury and vascular remodeling through oxidized phospholipids and impaired fibrinolysis [ 25 , 26 ] . However, the modest OR of 1.002 suggests a small effect size, indicating that LPa is likely a contributor rather than a primary driver of PH severity. This finding warrants cautious interpretation and further mechanistic studies to clarify LPa’s role in HPH pathogenesis, especially given its strong association with mortality (HR = 3.461, p < 0.001, Table 5 ). Cyanosis, observed in 64.6% of the cohort (405/627, Table 1 ), reflects severe hypoxemia (PO 2 ~ 74 mmHg) and was associated with an 81.4% increased odds of severe HPH. This aligns with the pathophysiology of HPH, where chronic hypoxia exacerbates pulmonary vasoconstriction and vascular resistance [ 8 ] . Right ventricular hypertrophy (OR = 3.501) underscores the downstream impact of sustained PASP elevation on right heart remodeling, a hallmark of advanced HPH that often precedes right heart failure [ 27 ] . The lack of association between chronic obstructive pulmonary disease (COPD) and HPH severity (p = 0.092, Table 3 ) contrasts with its established role in lowland PH type 3 [ 7 ] . This discrepancy may reflect milder COPD phenotypes in our high-altitude cohort, as detailed phenotyping (e.g., GOLD staging) was unavailable, with a prevalence of 42.6% (267/627, Table 1 ), or the dominant effect of hypoxia (PO2 ~ 74 mmHg, Table 2.1 ), which may overshadow airway obstruction’s contribution to HPH. High-altitude hypoxia likely exerts a more pronounced effect on pulmonary vascular resistance than COPD-related mechanisms in this population, though further studies with detailed COPD phenotyping are needed to confirm this hypothesis. Hemoglobin levels trended higher in the severe HPH group (165.21 ± 101.00 g/L vs. 152.97 ± 36.46 g/L, p = 0.059, Table 2 ), consistent with compensatory polycythemia—a common high-altitude adaptation—that may exacerbate pulmonary vasoconstriction by increasing blood viscosity [ 8 ] . Additionally, albumin levels were lower in the severe HPH group (33.50 ± 5.54 g/L vs. 35.45 ± 6.65 g/L, p < 0.001, Table 2 ), potentially reflecting malnutrition or liver dysfunction secondary to right heart failure, a frequent complication in advanced HPH. Cox regression analysis identified LPa (HR = 3.461, p < 0.001), atrial fibrillation (HR = 2.534, p = 0.003), heart failure (HR = 2.316, p = 0.021), and alcohol consumption (HR = 3.230, p = 0.013) as independent predictors of all-cause mortality (Table 5 ). LPa’s high hazard ratio underscores its prognostic significance, likely mediated by sustained vascular injury and right heart strain, as evidenced by elevated BNP levels (> 600 ng/L, Table 2 ) [ 28 ] . Atrial fibrillation, present in 13.7% of patients (86/627, Table 1 ), may reflect right atrial pressure overload, supported by the significantly larger right atrial diameter in the severe HPH group (47.67 ± 8.90 mm vs. 41.30 ± 7.75 mm, p < 0.001, Table 2 ). This increased right atrial diameter may contribute to the higher prevalence of atrial fibrillation, as increased right atrial pressure and remodeling are known to predispose to arrhythmias in PH [ 29 ] . Alternatively, hypoxia-induced electrophysiological changes may also play a role, both common in HPH progression [ 29 ] . Heart failure, more prevalent in the severe HPH group (33.7%, 90/267 vs. 21.1%, 76/360, p < 0.001, Table 3 ), indicates advanced disease and aligns with right ventricular failure as a terminal outcome in HPH [ 27 ] . Alcohol consumption’s strong association with mortality (HR = 3.230) is consistent with its exacerbation of hypoxia and cardiac stress, likely accelerating disease progression in this vulnerable population [ 30 ] . Notably, smoking lost significance in multivariate analysis (p = 0.538, Table 5 ), possibly due to its low prevalence (18%, 113/627, Table 1 ) or the overriding impact of hypoxia in this cohort. These findings offer practical implications for HPH management in high-altitude regions. Routine monitoring of APTT could facilitate early identification of patients at risk of severe HPH, particularly in settings with limited access to RHC. The association of elevated LPa with both HPH severity and mortality suggests a potential role for lipid-lowering therapies, though this hypothesis requires validation through clinical trials. Managing atrial fibrillation with rate control or anticoagulation and counseling patients to reduce alcohol intake may mitigate mortality risk, addressing modifiable factors in resource-scarce environments. Furthermore, the significant right heart remodeling observed in severe HPH, as indicated by increased right atrial diameter (47.67 ± 8.90 mm vs. 41.30 ± 7.75 mm, p < 0.001, Table 2 ), emphasizes the need for early intervention to prevent progression to right heart failure. Despite its contributions, this study has several limitations. Its retrospective, cross-sectional design precludes the assessment of causality and longitudinal PASP changes, limiting insights into disease progression. The single-center setting may introduce selection bias, potentially overrepresenting severe cases and skewing risk estimates. Reliance on echocardiography without RHC increases the risk of misclassification, particularly in hypoxic states where PASP overestimation is a concern. The absence of detailed COPD phenotyping, specific cause-of-death data, and consistent blood gas measurements restricts mechanistic precision. The exact number of patients lost to follow-up was not recorded, which may introduce bias in the mortality analysis, as these patients were excluded from survival analysis while their baseline data were retained for severity assessments. Telephone follow-up, while practical, resulted in incomplete mortality etiologies due to reliance on family recall, a common challenge in retrospective studies. Future prospective, multicenter studies incorporating RHC, comprehensive phenotyping (e.g., COPD severity, genetic variants in the HIF pathway), and longitudinal outcomes are essential to validate these findings and refine HPH management strategies. Conclusion In high-altitude residents of Qinghai, China, APTT, LPa, cyanosis, and right ventricular hypertrophy are associated with severe HPH, while LPa, atrial fibrillation, heart failure, and alcohol consumption predict mortality, reflecting chronic hypoxia’s impact in HPH. Routine monitoring of APTT, and potentially LPa, may aid in early detection, pending further validation of LPa’s role in HPH, while managing atrial fibrillation and alcohol use could reduce mortality risk in resource-limited settings. Prospective, multicenter studies with right heart catheterization are needed to validate these findings and refine HPH management strategies. Declarations Author contributions Shunjun Wang: Data collection (equal), data analysis (equal), writing - original manuscript (introduction). Laishun Yu: Data collection (equal), data analysis (equal). Luyang Huang: Data collection (equal), writing - original manuscript (methods). Xi Liu: Data collection (equal), writing - original manuscript (results). Fanyan Luo: Experimental design (equal), writing - review and editing (equal). Weixing Wang: Data collection (equal), statistical analysis (equal), writing - original manuscript (discussion). Lin Wang: Data collection (equal), data interpretation (equal), writing - review and editing (equal). Acknowledgments Fanyan Luo Weixin Wang and Lin Wang contributed equally to this article. Conflicts of Interest The authors declare no conflicts of interest. Data availability statement The data that support the findings of this study are available from the corresponding author upon reasonable request. Funding Information This work was supported by Foundation for the Qing Hai Province Health Commission Key project 2023-wjzd-12, Qing Hai Province Health Commission Guiding project 2020-wjzdx-13 and the Key Research Program of Jining City, Shandong Province (2021YXNS006). Ethics Statement Ethical approval was granted by the Ethics Committee of Qinghai Provincial People's Hospital (2022-55). References Champigneulle B, Brugniaux J V, Stauffer E, et al. Expedition 5300: limits of human adaptations in the highest city in the world[J]. J Physiol,2024,602(21):5449-5462. Dong Y, Dun B, Wang D P, et al. Therapeutic Erythrocytapheresis Is Effective in Treating High Altitude Polycythemia on the Qinghai-Tibet Plateau[J]. Wilderness Environ Med,2020,31(4):426-430. Lichtblau M, Saxer S, Furian M, et al. Cardiac function and pulmonary hypertension in Central Asian highlanders at 3250 m[J]. Eur Respir J,2020,56(2). Brito J, Siques P, Pena E. Long-term chronic intermittent hypoxia: a particular form of chronic high-altitude pulmonary hypertension[J]. Pulm Circ,2020,10(1 Suppl):5-12. Bussotti M, Marchese G. High Altitude Pulmonary Hypertension[J]. Cardiovasc Hematol Disord Drug Targets,2018,18(3):187-198. Hassoun P M. Pulmonary Arterial Hypertension[J]. N Engl J Med,2021,385(25):2361-2376. Nathan S D, Barbera J A, Gaine S P, et al. Pulmonary hypertension in chronic lung disease and hypoxia[J]. Eur Respir J,2019,53(1). Sydykov A, Mamazhakypov A, Maripov A, et al. Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders[J]. Int J Environ Res Public Health,2021,18(4). Humbert M, Kovacs G, Hoeper M M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Respir J,2023,61(1). Augustine D X, Coates-Bradshaw L D, Willis J, et al. Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography[J]. Echo Res Pract,2018,5(3):G11-G24. Siques P, Brito J, Ordenes S, et al. Involvement of overweight and lipid metabolism in the development of pulmonary hypertension under conditions of chronic intermittent hypoxia[J]. Pulm Circ,2020,10(1 Suppl):42-49. Wen B, Zhang G, Zhan C, et al. The 2024 revision of the Declaration of Helsinki: a modern ethical framework for medical research[J]. Postgrad Med J,2025,101(1194):371-382. Mukherjee M, Rudski L G, Addetia K, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography[J]. J Am Soc Echocardiogr,2025,38(3):141-186. Cossio-Aranda J, Zamora K D, Nanda N C, et al. Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect[J]. Echocardiography,2016,33(12):1891-1896. Zoghbi W A, Jone P N, Chamsi-Pasha M A, et al. Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography[J]. J Am Soc Echocardiogr,2024,37(1):2-63. Doppler echocardiography – Knowledge and References – Taylor & Francis[Z]. 2025:2025. Rashidi F, Sate H, Mohammadi A, et al. Echocardiographic evaluation of prevalence of pulmonary hypertension in beta-thalassemia major: A cross sectional study[J]. Pediatr Hematol Oncol,2018,35(5-6):322-330. D'Alto M, Bossone E, Opotowsky A R, et al. Strengths and weaknesses of echocardiography for the diagnosis of pulmonary hypertension[J]. Int J Cardiol,2018,263:177-183. Topyla-Putowska W, Tomaszewski M, Wysokinski A, et al. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations[J]. J Clin Med,2021,10(15). Jankowich M, Maron B A, Choudhary G. Mildly elevated pulmonary artery systolic pressure on echocardiography: bridging the gap in current guidelines[J]. Lancet Respir Med,2021,9(10):1185-1191. Dong T X, Zhu Q, Wang S T, et al. Diagnostic and prognostic value of echocardiography in pulmonary hypertension: an umbrella review of systematic reviews and meta-analyses[J]. BMC Pulm Med,2023,23(1):253. Forrer A, Gaisl T, Sevik A, et al. Partial Pressure of Arterial Oxygen in Healthy Adults at High Altitudes: A Systematic Review and Meta-Analysis[J]. JAMA Netw Open,2023,6(6):e2318036. Mathew R, Huang J, Wu J M, et al. Hematological disorders and pulmonary hypertension[J]. World J Cardiol,2016,8(12):703-718. Humbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: state of the art and research perspectives[J]. Eur Respir J,2019,53(1). Smolders V, Rodriguez C, Blanco I, et al. Metabolic profile in endothelial cells of chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension[J]. Sci Rep,2022,12(1):2283. Bousseau S, Sobrano F R, Gu S, et al. Pathophysiology and new advances in pulmonary hypertension[J]. BMJ Med,2023,2(1):e000137. Yang X, Liu H, Wu X. High-altitude pulmonary hypertension: a comprehensive review of mechanisms and management[J]. Clin Exp Med,2025,25(1):79. Vinci P, Di Girolamo F G, Panizon E, et al. Lipoprotein(a) as a Risk Factor for Cardiovascular Diseases: Pathophysiology and Treatment Perspectives[J]. Int J Environ Res Public Health,2023,20(18). Sammut M A, Condliffe R, Elliot C, et al. Atrial flutter and fibrillation in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension in the ASPIRE registry: Comparison of rate versus rhythm control approaches[J]. Int J Cardiol,2023,371:363-370. Lee D I, Kim S, Kang D O. Exploring the complex interplay between alcohol consumption and cardiovascular health: Mechanisms, evidence, and future directions[J]. Trends Cardiovasc Med,2025. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6055115","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":434458237,"identity":"46b2980b-e921-4ea8-883e-21ea1efbae05","order_by":0,"name":"Shunjun Wang","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Shunjun","middleName":"","lastName":"Wang","suffix":""},{"id":434458238,"identity":"cbac3e4c-978d-4f85-880c-3fb8d42eac6b","order_by":1,"name":"Laishun Yu","email":"","orcid":"","institution":"Qinghai Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Laishun","middleName":"","lastName":"Yu","suffix":""},{"id":434458239,"identity":"20220a1b-224e-4d98-9829-dbc90a4b7e9d","order_by":2,"name":"Luyang Huang","email":"","orcid":"","institution":"Qinghai Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Luyang","middleName":"","lastName":"Huang","suffix":""},{"id":434458240,"identity":"357ccbfe-fcce-4635-a043-b0b8b461b1a0","order_by":3,"name":"Xi Liu","email":"","orcid":"","institution":"Qinghai Provincial People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xi","middleName":"","lastName":"Liu","suffix":""},{"id":434458241,"identity":"82f11411-2f27-44b8-b9d0-0e7ea0f75cce","order_by":4,"name":"Fanyan Luo","email":"","orcid":"","institution":"Central South University","correspondingAuthor":false,"prefix":"","firstName":"Fanyan","middleName":"","lastName":"Luo","suffix":""},{"id":434458242,"identity":"fca70c6e-64c4-4f47-a3c5-ebcf4f92d1b8","order_by":5,"name":"Weixing Wang","email":"","orcid":"","institution":"Affiliated Hospital of Jining Medical","correspondingAuthor":false,"prefix":"","firstName":"Weixing","middleName":"","lastName":"Wang","suffix":""},{"id":434458243,"identity":"d7cbfa69-86b1-4b49-bd66-8b0324ee3fec","order_by":6,"name":"Lin Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIie3QMUvEMBTA8RcK1yWoY8ohfoVIoZwg+FVeKdwURRBuKmeg4FToqt9CF+dKIOdw4prhhk6HQ4ds3uBg1MkhvRsF8x8Cj+RHQgBCob9ax+G6iaunzv7MfDtBDuSu1sXx7e4EgNwbkY3pLoQvXtQbXq4ibpCPT8t5LuPqkUG58pPlxXSCfD1Klh2mQqtcUj1joNdekrUi48gV3VtgW5zLNpdMZIxI5Sev/Tdh4A6rE+kedtRvIUaknSP84LkgFZGRu4UOkzPTZ+6TFSa1jkitVXpDp1cT1H6SNCK19kPhfty8bzbl/LCJ1YOxpZ+4Ruz3+LXgEACI7PB+KBQK/fs+ARkXXQJxT7+mAAAAAElFTkSuQmCC","orcid":"","institution":"Central South University","correspondingAuthor":true,"prefix":"","firstName":"Lin","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-02-18 10:08:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6055115/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6055115/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79551088,"identity":"0053325a-d559-4b89-82e3-25c4b2fae5d7","added_by":"auto","created_at":"2025-03-31 06:38:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137905,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlow diagram showing the study design of HPH patients enrolled.*\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6055115/v1/a8dbaa453a2e5353a2ffa52c.png"},{"id":79552738,"identity":"225a5a6d-4a6d-4815-a4eb-1d7b2276e5a5","added_by":"auto","created_at":"2025-03-31 06:54:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1144228,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6055115/v1/a51fdc79-a59d-4b6b-97e7-bac270fcf2bd.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk Factors and Outcomes of HPH in High-Altitude Residents via echocardiographic evaluation ","fulltext":[{"header":"Research Significance","content":"\u003cp\u003eThis study identifies risk factors and clinical correlates of severe HPH in high-altitude residents, offering insights into HPH pathogenesis. Beyond advancing understanding, these findings hold potential implications for prevention and management in high-altitude regions. The association of LPa, APTT, cyanosis, and right ventricular hypertrophy with HPH severity, alongside mortality predictors like LPa, atrial fibrillation, heart failure, and alcohol consumption, suggests actionable targets. Routine screening for elevated LPa and APTT could facilitate early detection, while managing modifiable factors such as alcohol consumption and atrial fibrillation may mitigate disease progression and mortality, guiding strategies to reduce HPH burden where resources are scarce.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eGlobally, more than 80\u0026nbsp;million people permanently reside above 2,500 meters, with significant populations in South America (e.g., Aymara and Quechua), Central Asia (e.g., Tibetan and Sherpa), and East Africa (e.g., Ethiopian highlanders), where hypobaric hypoxia\u0026mdash;reducing inspiratory oxygen partial pressure to 74% of sea-level values\u0026mdash;poses a persistent physiological challenge\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e. In Qinghai Province, China, with an average elevation exceeding 3,000 meters, over 5\u0026nbsp;million individuals live between 3,000 and 5,000 meters, increasing the prevalence of HPH, a subtype of PH driven by chronic low oxygen levels\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. This high-altitude context presents unique public health challenges due to limited medical resources and sustained environmental stress.\u003c/p\u003e \u003cp\u003eThe adaptability to altitude hypoxia varies significantly among different populations, depending on the length of exposure. This exposure can be classified as chronic, acute, or intermittent hypoxia\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. HPH, a subtype of pulmonary hypertension(PH) caused by lung disease or hypoxia, has become a major public health concern in mountainous areas due to prolonged exposure to low oxygen levels\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. PH affects approximately 1% of the global population, with the prevalence rising to 10% in people over 65 years of age\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. HPH is often accompanied by other diseases, such as chronic obstructive pulmonary disease (COPD), sleep apnea syndrome, and hypoxic pulmonary heart disease, complicating its diagnosis and management\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Clinical symptoms of HPH include progressive exercise dyspnea, right heart failure, and premature death\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. Changes in the adaptive response to hypoxia and the development of HPH are currently thought to be linked to genetic, environmental, or other diseases\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe current diagnostic standard for PH is right heart catheterization (RHC) to measure pulmonary systolic blood pressure (PASP)\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. However, due to the invasive nature and high cost of RHC, echocardiography has become a widely used, non-invasive method for assessing PH, especially in high-altitude areas\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Doppler echocardiography has proven to be a reliable method for evaluating pulmonary artery pressure\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. Recent studies have shown that exposure to hypoxia can trigger various metabolic reactions, including changes in lipid metabolism, which are implicated in the development of high-altitude PH\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. This study aims to explore the factors that promote the progression of PH in high-altitude residents and the impact of these risk factors on the survival rate of patients with HPH.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eResearch Design\u003c/p\u003e \u003cp\u003eThis single-center retrospective study analyzed clinical data from Qinghai Provincial People\u0026rsquo;s Hospital (Qinghai, China) between January 2018 and December 2022. It adhered to the Declaration of Helsinki, with informed consent obtained via telephone follow-up\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. The protocol was approved by the Ethics Committee of Qinghai Provincial People\u0026rsquo;s Hospital (2022-55).\u003c/p\u003e \u003cp\u003eResearch Population\u003c/p\u003e \u003cp\u003eWe enrolled 627 patients diagnosed with HPH (PASP\u0026thinsp;\u0026ge;\u0026thinsp;50 mmHg) via echocardiography. Patients were categorized based solely on PASP into moderate HPH (50\u0026thinsp;\u0026le;\u0026thinsp;PASP\u0026thinsp;\u0026lt;\u0026thinsp;70 mmHg) and severe HPH (PASP\u0026thinsp;\u0026ge;\u0026thinsp;70 mmHg) groups\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e. Exclusion criteria were: (1) age\u0026thinsp;\u0026lt;\u0026thinsp;18 or \u0026gt;\u0026thinsp;80 years; (2) history of cardiac surgery; (3) presence of malignant tumors; (4) severe systemic diseases affecting major organs (e.g., liver, kidney, heart, brain, lung) or endocrine systems, unrelated to PH; (5) HIV infection; (6) liver or kidney failure; (7) pregnancy or lactation; (8) congenital heart disease or valvular disease; (9) incomplete clinical data. The study design is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eClinical Data Collection\u003c/p\u003e \u003cp\u003eData were collected using Haitai Software 3.0 from medical records, including age, sex, ethnicity, body mass index (BMI), smoking, alcohol consumption, COPD, diabetes, exertional dyspnea, cyanosis, atrial fibrillation, NYHA class, hemoglobin (HB), hematocrit (HCT), C-reactive protein (CRP), albumin, creatinine, urea, B-type natriuretic peptide (BNP), prothrombin time (PT), activated partial thromboplastin time (APTT), lipoprotein(a) (LPa), and LDL/HDL ratio. Cyanosis was defined as visible bluish discoloration of the skin, lips, or nail beds, assessed clinically without consistent blood gas confirmation. Mortality data were obtained through telephone follow-up by trained staff at least 1 year post-admission, querying family members or caregivers, not sourced from community centers.\u003c/p\u003e \u003cp\u003eEchocardiography\u003c/p\u003e \u003cp\u003eEchocardiography was performed using the Philips EPIQ7 system, following the guidelines of the American Society of Echocardiography\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. All enrolled patients underwent Doppler echocardiography, as described in \u003cem\u003eDoppler Echocardiography \u0026ndash; Knowledge and References\u003c/em\u003e by Taylor \u0026amp; Francis\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. Continuous Doppler was used to measure the peak velocity of the tricuspid regurgitation jet, while pulsed Doppler assessed the peak velocity curves of pulmonary artery blood flow and the right ventricular outflow tract. In the absence of right ventricular outflow tract obstruction, right ventricular systolic pressure reflects PASP. PASP was estimated by combining the peak tricuspid regurgitation velocity with right atrial pressure, which was determined from the inferior vena cava diameter and its respiratory changes. If tricuspid regurgitation velocity was difficult to obtain, alternative measures such as early diastolic pulmonary regurgitation velocity or right ventricular outflow Doppler acceleration time were considered\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Data on PH diagnosis and treatment were evaluated against the 2022 ESC/ERS Guidelines\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Certified cardiologists conducted the echocardiography, adhering to both ASE guidelines and the heart color Doppler ultrasound protocols of Fuwai Hospital, ensuring standardized imaging and interpretation to reduce variability and improve accuracy.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using SPSS 26.0. Continuous variables (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) were compared using t-tests (equal variances assumed unless Levine\u0026rsquo;s test indicated otherwise), and categorical variables (frequencies, %) via chi-square tests. Logistic regression was used to identify factors associated with severe HPH due to its ability to model binary outcomes and estimate odds ratios (ORs). Cox proportional hazards regression was selected to evaluate mortality predictors, analyzing time-to-event data and providing hazard ratios (HRs). Multivariate Cox models adjusted for LPa, LDL/HDL ratio, atrial fibrillation, right ventricular hypertrophy, heart failure, smoking, and alcohol consumption using a forced entry approach. *p*\u0026lt;0.05 indicated significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e1. General information of the research patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBetween January 2018 and June 2020, this retrospective study collected and analyzed the medical records of 627 patients who were hospitalized and assessed for HPH. According to the results of echocardiography, PASP is estimated to be less than or equal to 70mmHg, and PASP greater than 50mmHg is moderate PASP group, and PASP greater than 70mmHg is defined as severe \u0026nbsp;PASP group. Among them, there were 360 patients (57.4%) with 50\u0026le;PASP\u0026lt;70mmHg and 267 patients (42.6%) with PASP\u0026ge;70mmHg. There were 161 patients under 60 years old (25.7%) and 466 patients \u0026ge;60 years old (74.3%). There were 299 (47.7%) female patients and 328 (52.3%) male patients. The patients included in the study were mainly Han, Hui and Tibetan. Smoking and alcohol consumption accounted for less than 20 percent of the study population. There were 206 people (32.9%) with BMI\u0026ge;24 and 69 people (11%) with diabetes. Of the total study population, 267 (42.6%) had COPD and 329 (52.5%) had exertional dyspnea and 405 (64.6%) had significant cyanosis. This study also included basic data such as atrial fibrillation and NYHA cardiac function, as shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Baseline data table\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"589\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003eNumber（%）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e＜60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e161（25.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e466（74.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e299（47.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e328（52.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEthnic\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ehan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e392（62.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTibetan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e66（10.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eHui\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e122（19.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eothers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e47（7.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e514（82.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e113（18.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDrinking\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e559（89.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e68（10.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e558（89.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e69（11.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026lt; 24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e421（67.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e≧24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e206（32.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e360（57.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e267（42.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eExertional dyspnea\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e298（47.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e329（52.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eCyanosis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e222（35.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e405（64.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e541（86.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e86（13.7）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePASP\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e50-70mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e360（57.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e≧70 mmHg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e267（42.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eNYHA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e216（34.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e80（12.8）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e240（38.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 287px;\"\u003e\n \u003cp\u003e91（14.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Relationship between Clinical Parameters and PASP in HPH Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study compared clinical, hematological, coagulation, and echocardiographic parameters between high-altitude residents with hypoxic HPH categorized by PASP into moderate (50\u0026nbsp;\u0026le;\u0026nbsp;PASP \u0026lt; 70 mmHg, n=360) and severe (PASP\u0026nbsp;\u0026ge;70 mmHg, n=267) groups, as assessed by echocardiography. \u0026nbsp;Patients with severe HPH exhibited significantly lower albumin levels (33.50\u0026nbsp;\u0026plusmn;\u0026nbsp;5.54 g/L vs. 35.45\u0026nbsp;\u0026plusmn;\u0026nbsp;6.65 g/L, p \u0026lt; 0.001), PT; \u0026nbsp;14.42\u0026nbsp;\u0026plusmn;\u0026nbsp;4.99 s vs. 13.56\u0026nbsp;\u0026plusmn;\u0026nbsp;3.46 s, p = 0.011, APTT; \u0026nbsp; 34.04\u0026nbsp;\u0026plusmn;\u0026nbsp;7.48 s vs. 31.44\u0026nbsp;\u0026plusmn;\u0026nbsp;6.91 s, p \u0026lt; 0.001, D-dimer (0.81\u0026nbsp;\u0026plusmn;\u0026nbsp;0.62 mg/L vs. 0.58\u0026nbsp;\u0026plusmn;\u0026nbsp;0.40 mg/L, p \u0026lt; 0.001), LPa; \u0026nbsp;142.27\u0026nbsp;\u0026plusmn;\u0026nbsp;126.64 mg/L vs. 110.67\u0026nbsp;\u0026plusmn;\u0026nbsp;101.01 mg/L, p = 0.001, and LDL/HDL ratio (2.50\u0026nbsp;\u0026plusmn;\u0026nbsp;0.98 vs. 2.33\u0026nbsp;\u0026plusmn;\u0026nbsp;0.86, p = 0.022) compared to the moderate HPH group (Table 2). Hemoglobin (Hb) levels were higher in the severe HPH group (165.21\u0026nbsp;\u0026plusmn;\u0026nbsp;101.00 g/L vs. 152.97\u0026nbsp;\u0026plusmn;\u0026nbsp;36.46 g/L, p = 0.059), potentially reflecting high-altitude polycythemia, which may increase blood viscosity and contribute to elevated pulmonary artery pressure. \u0026nbsp; Additionally, the severe HPH group showed a larger right atrial diameter (47.67\u0026nbsp;\u0026plusmn;\u0026nbsp;8.90 mm vs. 41.30\u0026nbsp;\u0026plusmn;\u0026nbsp;7.75 mm, p \u0026lt; 0.001), indicating more pronounced right heart remodeling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Clinical and Imaging Parameters in HPH Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e50＜PASP＜70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003ePASP\u0026ge;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003et/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eHB(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e152.97\u0026plusmn;36.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e165.21\u0026plusmn;101.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eMononuclear (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e8.13\u0026plusmn;2.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e8.42\u0026plusmn;2.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.190\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eHCT(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e49.49\u0026plusmn;32.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e49.59\u0026plusmn;13.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eCRP(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.33\u0026plusmn;4.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.59\u0026plusmn;4.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.677\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eAlbumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e35.45\u0026plusmn;6.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e33.50\u0026plusmn;5.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eCreatinine (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e78.82\u0026plusmn;47.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e79.32\u0026plusmn;40.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.888\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eCarbamide (\u0026micro;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e7.48\u0026plusmn;4.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e10.72\u0026plusmn;35.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.726\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eBNP(ng/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e610.63\u0026plusmn;914.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e602.67\u0026plusmn;657.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.899\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003ePT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e13.56\u0026plusmn;3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e14.42\u0026plusmn;4.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-2.536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eAPTT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e31.44\u0026plusmn;6.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e34.04\u0026plusmn;7.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-4.489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eD-Dimer (mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.58\u0026plusmn;0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0.81\u0026plusmn;0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-5.685\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eLPa (mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e110.67\u0026plusmn;101.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e142.27\u0026plusmn;126.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-3.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eLDL/HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.33\u0026plusmn;.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.50\u0026plusmn;.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-2.302\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.022*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eright atrial diameter\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e41.30\u0026plusmn;7.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e47.67\u0026plusmn;8.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-9.556\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eLAVI(mL/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e29.02\u0026plusmn;7.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e27.99\u0026plusmn;5.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.924\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e*Note: *p*\u0026lt;0.05 indicates statistical significance.*\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.1 Arterial Blood Gas Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe arterial blood gas analysis revealed no statistically significant differences between the moderate HPH group (50 \u0026lt; PASP \u0026lt; 70 mmHg) and the severe HPH group (PASP \u0026ge; 70 mmHg) in terms of key parameters. \u0026nbsp;Specifically, the partial pressure of oxygen (PO₂) was 74.30 \u0026plusmn; 19.44 mmHg in the moderate group compared to 73.51 \u0026plusmn; 19.39 mmHg in the severe group (p = 0.618). \u0026nbsp;Similarly, the partial pressure of carbon dioxide (PCO₂) was 34.92 \u0026plusmn; 7.04 mmHg versus 34.16 \u0026plusmn; 6.09 mmHg (p = 0.159), and oxygen saturation (SO₂) was 92.61\u0026nbsp;\u0026plusmn;\u0026nbsp;5.18% versus 92.10\u0026nbsp;\u0026plusmn;\u0026nbsp;5.29% (p = 0.226). \u0026nbsp;Additionally, lactate levels (LAC) were comparable between the two groups, with values of 2.02\u0026nbsp;\u0026plusmn;\u0026nbsp;1.45 mmol/L in the moderate group and 1.91\u0026nbsp;\u0026plusmn;\u0026nbsp;0.81 mmol/L in the severe group (p = 0.244). \u0026nbsp; These findings suggest that arterial blood gas parameters do not significantly differ based on the severity of HPH in this cohort (Table 2.1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.1: Comparison of Arterial Blood Gas Parameters\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e50＜PASP＜70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003ePASP\u0026ge;70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003et/F\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003ePO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e74.30\u0026plusmn;19.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e73.51\u0026plusmn;19.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003ePCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e34.92\u0026plusmn;7.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e34.16\u0026plusmn;6.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.410\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eSO\u003csub\u003e2\u003c/sub\u003e (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e92.61\u0026plusmn;5.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e92.10\u0026plusmn;5.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 148px;\"\u003e\n \u003cp\u003eLAC (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e2.02\u0026plusmn;1.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1.91\u0026plusmn;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.167\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.244\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\u0026nbsp;\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e3. Relationship between pulmonary artery pressure and general clinical data and clinical symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the experimental results, the severity of PASP in patients with HPH was significantly correlated with right ventricular hypertrophy, cyanosis, heart failure, and NYHA cardiac function grade (p\u0026lt;0.05), with the boundary of pulmonary artery pressure estimated by echocardiographic at 70mmHg. The results of this experiment showed that there was no significant correlation between the severity of HPH and age, sex, ethnicity, BMI, smoking, drinking and diabetes (p\u0026gt;0.05). Whether patients suffer from atrial fibrillation and COPD may be correlated with the severity of HPH (p=0.092, p=0.074), and the sample size needs to be further expanded for verification (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Association Between Clinical Indicators and HPH Severity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"591\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e50-70 (n=360)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026ge;70 (n=267)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eAge \u0026lt;60 /\u0026nbsp;\u0026ge;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e96 / 264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e65 / 202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eSex Female / Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e174 / 186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e125 / 142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.707\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eEthnicity Han / Tibetan / Hui / Others\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e223 / 36 / 72 / 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e169 / 30 / 50 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.748\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eBMI \u0026lt;24 /\u0026nbsp;\u0026ge;24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e249 / 111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e172 / 95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.211\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eSmoking No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e301 / 59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e213 / 54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.217\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eDrinking No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e317 / 43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e242 / 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e1.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.304\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eCOPD No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e217 / 143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e143 / 124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e2.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.092\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eDiabetes No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e321 / 39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e237 / 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.873\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eNYHA 1 / 2 / 3 / 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e140 / 47 / 128 / 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e76 / 33 / 112 / 46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e8.892\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.031*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eHeart Failure No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e284 / 76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e177 / 90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e12.497\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eCyanosis No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e152 / 208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e70 / 197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e17.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eAtrial Fibrillation No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e303 / 57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e238 / 29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e3.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eRight Ventricular Hypertrophy No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e350 / 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e235 / 32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e20.794\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.0001*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 181px;\"\u003e\n \u003cp\u003eExertional Dyspnea No / Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e166 / 194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e132 / 135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Note: *p*\u0026lt;0.05 indicates statistical significance.*\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Multivariate Logistic regression analysis results of patients with moderate to severe HPH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multivariate logistic regression analysis was performed to identify risk factors associated with the progression of HPH from moderate to severe, using variables that showed statistically significant differences between the two groups. The results indicated that laboratory markers APTT (OR = 1.050, 95% CI: 1.014\u0026ndash;1.087, p = 0.007) and LPa (OR = 1.002, 95% CI: 1.001\u0026ndash;1.004, p = 0.003) were significant risk factors for the progression of HPH to severe. Additionally, clinical factors such as cyanosis (OR = 1.814, 95% CI: 1.235\u0026ndash;2.663, p = 0.002) and right ventricular hypertrophy (OR = 3.501, 95% CI: 1.631\u0026ndash;7.514, p = 0.001) were strongly associated with an increased risk of progression to severe HPH. In contrast, other variables, including PT, LDL/HDL, NYHA classification, heart failure, atrial fibrillation, and albumin, were not significantly associated with the progression of HPH to severe (p \u0026gt; 0.05). (Table 4)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Multivariate Logistic regression analysis of risk factors for moderate-to-severe HPH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u003cimg 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\" width=\"815\" height=\"417\"\u003e\u003c/p\u003e\n\u003cp\u003e*Note: *p*\u0026lt;0.05 indicates statistical significance. * Forest Plot of Logistic Regression Results for Severe HPH Risk Factors. Caption: Visualizes ORs and 95% CIs from Table 4.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Factors Associated with Mortality in High-Altitude Residents with HPH\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study included high-altitude residents diagnosed with HPH via echocardiography (PASP \u0026ge;50 mmHg) at a tertiary hospital in Qinghai, China, with continuous follow-up for at least one year to assess mortality. Univariate Cox regression analysis identified LPa (HR = 2.946, 95% CI: 1.759\u0026ndash;4.935, p \u0026lt; 0.001), atrial fibrillation (HR = 2.120, 95% CI: 1.162\u0026ndash;3.867, p = 0.014), and alcohol consumption (HR = 2.218, 95% CI: 1.200\u0026ndash;4.101, p = 0.011) as significant predictors of mortality (Table 5). Multivariate Cox regression, adjusted for LPa, LDL/HDL ratio, atrial fibrillation, right ventricular hypertrophy, heart failure, smoking, and alcohol consumption, further confirmed LPa (HR = 3.461, 95% CI: 2.021\u0026ndash;5.928, p \u0026lt; 0.001), atrial fibrillation (HR = 2.534, 95% CI: 1.365\u0026ndash;4.705, p = 0.003), heart failure (HR = 2.316, 95% CI: 1.134\u0026ndash;4.730, p = 0.021), and alcohol consumption (HR = 3.230, 95% CI: 1.277\u0026ndash;8.171, p = 0.013) as independent risk factors for mortality. These findings highlight the prognostic significance of LPa, atrial fibrillation, heart failure, and alcohol consumption in HPH patients, underscoring the need for targeted risk management strategies in this population.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. COX regression analysis of patients with moderate to severe HPH\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"565\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eUniveriate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 207px;\"\u003e\n \u003cp\u003eMultiveriate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 140px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 50px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 65px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 98px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 53px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 93px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eLPa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2.946\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.759-4.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.001*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.461\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e2.021-5.928\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eLDL/HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.798-2.201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.742-2.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eAtrial fibrillation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.014*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.162-3.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.003*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.534\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.365-4.705\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eRight ventricular hypertrophy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.742-4.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.917\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.743-4.950\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.973\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.971-4.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.021*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.134-4.730\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003esmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.087\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e1.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0.930-2.921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e0.328-1.789\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 140px;\"\u003e\n \u003cp\u003edrinking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.011*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e2.218\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1.200-4.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e0.013*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e3.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 93px;\"\u003e\n \u003cp\u003e1.277-8.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Note: *p*\u0026lt;0.05 indicates statistical significance.*\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study employed Doppler echocardiography to estimate PASP in a cohort of 627 high-altitude residents in Qinghai, China, where chronic hypoxia at elevations exceeding 3,000 meters significantly increases the risk of HPH. Echocardiography provides a practical, non-invasive alternative to RHC in resource-limited high-altitude settings; however, its limitations warrant careful consideration. Echocardiography may overestimate PASP in the presence of high-altitude polycythemia, altered thoracic anatomy, or elevated cardiac output, potentially leading to false-positive diagnoses of PH\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. This overestimation can complicate clinical decision-making, particularly in high-altitude settings where even mild PASP elevations may be misinterpreted as pathological, a challenge highlighted by Jankowich et al., who note the lack of clear guidelines for managing such cases\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Compared to RHC\u0026mdash;the gold standard, which directly measures mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance\u0026mdash;echocardiography\u0026rsquo;s sensitivity and specificity for PH diagnosis range from 85\u0026ndash;88% and 63\u0026ndash;87%, respectively\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. In high-altitude populations, where chronic hypoxia alters hemodynamics, these discrepancies may be amplified, particularly due to the lack of validation studies specifically addressing echocardiography\u0026rsquo;s accuracy in such contexts\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Arterial blood gas analysis in our cohort revealed a PO2 of approximately 74 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2.1\u003c/span\u003e), confirming chronic hypoxia consistent with expected declines at this altitude (~\u0026thinsp;12 mmHg per 1,600 m)\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. However, the absence of significant differences in PO\u003csub\u003e2\u003c/sub\u003e (p\u0026thinsp;=\u0026thinsp;0.618) and SO\u003csub\u003e2\u003c/sub\u003e (p\u0026thinsp;=\u0026thinsp;0.226) between the moderate (50\u0026thinsp;\u0026le;\u0026thinsp;PASP\u0026thinsp;\u0026lt;\u0026thinsp;70 mmHg) and severe (PASP\u0026thinsp;\u0026ge;\u0026thinsp;70 mmHg) HPH groups suggests a uniform hypoxic burden across severity levels. This may be attributed to the high baseline altitude (\u0026gt;\u0026thinsp;3,000 m) in Qinghai, where compensatory mechanisms such as polycythemia (Hb 165.21\u0026thinsp;\u0026plusmn;\u0026thinsp;101.00 g/L in severe HPH vs. 152.97\u0026thinsp;\u0026plusmn;\u0026thinsp;36.46 g/L in moderate HPH, p\u0026thinsp;=\u0026thinsp;0.059, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) may mitigate oxygenation differences, potentially masking severity-specific variations in oxygenation.\u003c/p\u003e \u003cp\u003eLogistic regression analysis identified APTT (OR\u0026thinsp;=\u0026thinsp;1.050, 95% CI: 1.014\u0026ndash;1.087, p\u0026thinsp;=\u0026thinsp;0.007), LPa (OR\u0026thinsp;=\u0026thinsp;1.002, 95% CI: 1.001\u0026ndash;1.004, p\u0026thinsp;=\u0026thinsp;0.003), cyanosis (OR\u0026thinsp;=\u0026thinsp;1.814, 95% CI: 1.235\u0026ndash;2.663, p\u0026thinsp;=\u0026thinsp;0.002), and right ventricular hypertrophy (OR\u0026thinsp;=\u0026thinsp;3.501, 95% CI: 1.631\u0026ndash;7.514, p\u0026thinsp;=\u0026thinsp;0.001) as independent factors associated with severe HPH (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Elevated APTT in the severe HPH group (34.04\u0026thinsp;\u0026plusmn;\u0026thinsp;7.48 s vs. 31.44\u0026thinsp;\u0026plusmn;\u0026thinsp;6.91 s, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) suggests a coagulopathy, potentially driven by hypoxia-induced endothelial dysfunction or microthrombosis, both of which contribute to increased pulmonary vascular resistance\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e. This observation is consistent with prior evidence that chronic hypoxia disrupts hemostatic balance, although the precise mechanisms underlying coagulopathy in HPH remain underexplored\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e. Notably, D-dimer levels were also significantly elevated in the severe HPH group (0.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.62 mg/L vs. 0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40 mg/L, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), reinforcing the presence of a pro-thrombotic state in advanced HPH. These coagulation abnormalities highlight a potential therapeutic avenue, as anticoagulation or anti-thrombotic strategies may mitigate disease severity, though clinical trials are needed to establish their efficacy in this population.\u003c/p\u003e \u003cp\u003eThe association of LPa with severe HPH is particularly intriguing. LPa, a pro-atherogenic and pro-thrombotic lipoprotein, was significantly elevated in the severe HPH group (142.27\u0026thinsp;\u0026plusmn;\u0026thinsp;126.64 mg/L vs. 110.67\u0026thinsp;\u0026plusmn;\u0026thinsp;101.01 mg/L, p\u0026thinsp;=\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Its role in HPH may involve hypoxia-driven alterations in lipid metabolism, promoting endothelial injury and vascular remodeling through oxidized phospholipids and impaired fibrinolysis\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. However, the modest OR of 1.002 suggests a small effect size, indicating that LPa is likely a contributor rather than a primary driver of PH severity. This finding warrants cautious interpretation and further mechanistic studies to clarify LPa\u0026rsquo;s role in HPH pathogenesis, especially given its strong association with mortality (HR\u0026thinsp;=\u0026thinsp;3.461, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Cyanosis, observed in 64.6% of the cohort (405/627, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), reflects severe hypoxemia (PO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;~\u0026thinsp;74 mmHg) and was associated with an 81.4% increased odds of severe HPH. This aligns with the pathophysiology of HPH, where chronic hypoxia exacerbates pulmonary vasoconstriction and vascular resistance\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Right ventricular hypertrophy (OR\u0026thinsp;=\u0026thinsp;3.501) underscores the downstream impact of sustained PASP elevation on right heart remodeling, a hallmark of advanced HPH that often precedes right heart failure\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe lack of association between chronic obstructive pulmonary disease (COPD) and HPH severity (p\u0026thinsp;=\u0026thinsp;0.092, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e) contrasts with its established role in lowland PH type 3\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. This discrepancy may reflect milder COPD phenotypes in our high-altitude cohort, as detailed phenotyping (e.g., GOLD staging) was unavailable, with a prevalence of 42.6% (267/627, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), or the dominant effect of hypoxia (PO2\u0026thinsp;~\u0026thinsp;74 mmHg, Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2.1\u003c/span\u003e), which may overshadow airway obstruction\u0026rsquo;s contribution to HPH. High-altitude hypoxia likely exerts a more pronounced effect on pulmonary vascular resistance than COPD-related mechanisms in this population, though further studies with detailed COPD phenotyping are needed to confirm this hypothesis. Hemoglobin levels trended higher in the severe HPH group (165.21\u0026thinsp;\u0026plusmn;\u0026thinsp;101.00 g/L vs. 152.97\u0026thinsp;\u0026plusmn;\u0026thinsp;36.46 g/L, p\u0026thinsp;=\u0026thinsp;0.059, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), consistent with compensatory polycythemia\u0026mdash;a common high-altitude adaptation\u0026mdash;that may exacerbate pulmonary vasoconstriction by increasing blood viscosity\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e. Additionally, albumin levels were lower in the severe HPH group (33.50\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54 g/L vs. 35.45\u0026thinsp;\u0026plusmn;\u0026thinsp;6.65 g/L, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), potentially reflecting malnutrition or liver dysfunction secondary to right heart failure, a frequent complication in advanced HPH.\u003c/p\u003e \u003cp\u003eCox regression analysis identified LPa (HR\u0026thinsp;=\u0026thinsp;3.461, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), atrial fibrillation (HR\u0026thinsp;=\u0026thinsp;2.534, p\u0026thinsp;=\u0026thinsp;0.003), heart failure (HR\u0026thinsp;=\u0026thinsp;2.316, p\u0026thinsp;=\u0026thinsp;0.021), and alcohol consumption (HR\u0026thinsp;=\u0026thinsp;3.230, p\u0026thinsp;=\u0026thinsp;0.013) as independent predictors of all-cause mortality (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e). LPa\u0026rsquo;s high hazard ratio underscores its prognostic significance, likely mediated by sustained vascular injury and right heart strain, as evidenced by elevated BNP levels (\u0026gt;\u0026thinsp;600 ng/L, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e. Atrial fibrillation, present in 13.7% of patients (86/627, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), may reflect right atrial pressure overload, supported by the significantly larger right atrial diameter in the severe HPH group (47.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90 mm vs. 41.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This increased right atrial diameter may contribute to the higher prevalence of atrial fibrillation, as increased right atrial pressure and remodeling are known to predispose to arrhythmias in PH\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Alternatively, hypoxia-induced electrophysiological changes may also play a role, both common in HPH progression\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. Heart failure, more prevalent in the severe HPH group (33.7%, 90/267 vs. 21.1%, 76/360, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e), indicates advanced disease and aligns with right ventricular failure as a terminal outcome in HPH\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. Alcohol consumption\u0026rsquo;s strong association with mortality (HR\u0026thinsp;=\u0026thinsp;3.230) is consistent with its exacerbation of hypoxia and cardiac stress, likely accelerating disease progression in this vulnerable population\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Notably, smoking lost significance in multivariate analysis (p\u0026thinsp;=\u0026thinsp;0.538, Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e), possibly due to its low prevalence (18%, 113/627, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) or the overriding impact of hypoxia in this cohort.\u003c/p\u003e \u003cp\u003eThese findings offer practical implications for HPH management in high-altitude regions. Routine monitoring of APTT could facilitate early identification of patients at risk of severe HPH, particularly in settings with limited access to RHC. The association of elevated LPa with both HPH severity and mortality suggests a potential role for lipid-lowering therapies, though this hypothesis requires validation through clinical trials. Managing atrial fibrillation with rate control or anticoagulation and counseling patients to reduce alcohol intake may mitigate mortality risk, addressing modifiable factors in resource-scarce environments. Furthermore, the significant right heart remodeling observed in severe HPH, as indicated by increased right atrial diameter (47.67\u0026thinsp;\u0026plusmn;\u0026thinsp;8.90 mm vs. 41.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.75 mm, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), emphasizes the need for early intervention to prevent progression to right heart failure.\u003c/p\u003e \u003cp\u003eDespite its contributions, this study has several limitations. Its retrospective, cross-sectional design precludes the assessment of causality and longitudinal PASP changes, limiting insights into disease progression. The single-center setting may introduce selection bias, potentially overrepresenting severe cases and skewing risk estimates. Reliance on echocardiography without RHC increases the risk of misclassification, particularly in hypoxic states where PASP overestimation is a concern. The absence of detailed COPD phenotyping, specific cause-of-death data, and consistent blood gas measurements restricts mechanistic precision. The exact number of patients lost to follow-up was not recorded, which may introduce bias in the mortality analysis, as these patients were excluded from survival analysis while their baseline data were retained for severity assessments. Telephone follow-up, while practical, resulted in incomplete mortality etiologies due to reliance on family recall, a common challenge in retrospective studies. Future prospective, multicenter studies incorporating RHC, comprehensive phenotyping (e.g., COPD severity, genetic variants in the HIF pathway), and longitudinal outcomes are essential to validate these findings and refine HPH management strategies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn high-altitude residents of Qinghai, China, APTT, LPa, cyanosis, and right ventricular hypertrophy are associated with severe HPH, while LPa, atrial fibrillation, heart failure, and alcohol consumption predict mortality, reflecting chronic hypoxia\u0026rsquo;s impact in HPH. Routine monitoring of APTT, and potentially LPa, may aid in early detection, pending further validation of LPa\u0026rsquo;s role in HPH, while managing atrial fibrillation and alcohol use could reduce mortality risk in resource-limited settings. Prospective, multicenter studies with right heart catheterization are needed to validate these findings and refine HPH management strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eShunjun Wang: Data collection (equal), data analysis (equal), writing - original manuscript (introduction). Laishun Yu: Data collection (equal), data analysis (equal). Luyang Huang: Data collection (equal), writing - original manuscript (methods). Xi Liu: Data collection (equal), writing - original manuscript (results). Fanyan Luo: Experimental design (equal), writing - review and editing (equal). Weixing Wang: Data collection (equal), statistical analysis (equal), writing - original manuscript (discussion). Lin Wang: Data collection (equal), data interpretation (equal), writing - review and editing (equal).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFanyan Luo Weixin Wang and Lin Wang contributed equally to this article. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the corresponding author upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by Foundation for the Qing Hai Province Health Commission Key project \u0026nbsp; 2023-wjzd-12, Qing Hai Province Health Commission Guiding project 2020-wjzdx-13 and the Key Research Program of Jining City, Shandong Province (2021YXNS006). \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was granted by the Ethics Committee of Qinghai Provincial People\u0026apos;s Hospital (2022-55).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChampigneulle B, Brugniaux J V, Stauffer E, et al. Expedition 5300: limits of human adaptations in the highest city in the world[J]. J Physiol,2024,602(21):5449-5462.\u003c/li\u003e\n\u003cli\u003eDong Y, Dun B, Wang D P, et al. Therapeutic Erythrocytapheresis Is Effective in Treating High Altitude Polycythemia on the Qinghai-Tibet Plateau[J]. Wilderness Environ Med,2020,31(4):426-430.\u003c/li\u003e\n\u003cli\u003eLichtblau M, Saxer S, Furian M, et al. Cardiac function and pulmonary hypertension in Central Asian highlanders at 3250 m[J]. Eur Respir J,2020,56(2).\u003c/li\u003e\n\u003cli\u003eBrito J, Siques P, Pena E. Long-term chronic intermittent hypoxia: a particular form of chronic high-altitude pulmonary hypertension[J]. Pulm Circ,2020,10(1 Suppl):5-12.\u003c/li\u003e\n\u003cli\u003eBussotti M, Marchese G. High Altitude Pulmonary Hypertension[J]. Cardiovasc Hematol Disord Drug Targets,2018,18(3):187-198.\u003c/li\u003e\n\u003cli\u003eHassoun P M. Pulmonary Arterial Hypertension[J]. N Engl J Med,2021,385(25):2361-2376.\u003c/li\u003e\n\u003cli\u003eNathan S D, Barbera J A, Gaine S P, et al. Pulmonary hypertension in chronic lung disease and hypoxia[J]. Eur Respir J,2019,53(1).\u003c/li\u003e\n\u003cli\u003eSydykov A, Mamazhakypov A, Maripov A, et al. Pulmonary Hypertension in Acute and Chronic High Altitude Maladaptation Disorders[J]. Int J Environ Res Public Health,2021,18(4).\u003c/li\u003e\n\u003cli\u003eHumbert M, Kovacs G, Hoeper M M, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension[J]. Eur Respir J,2023,61(1).\u003c/li\u003e\n\u003cli\u003eAugustine D X, Coates-Bradshaw L D, Willis J, et al. Echocardiographic assessment of pulmonary hypertension: a guideline protocol from the British Society of Echocardiography[J]. Echo Res Pract,2018,5(3):G11-G24.\u003c/li\u003e\n\u003cli\u003eSiques P, Brito J, Ordenes S, et al. Involvement of overweight and lipid metabolism in the development of pulmonary hypertension under conditions of chronic intermittent hypoxia[J]. Pulm Circ,2020,10(1 Suppl):42-49.\u003c/li\u003e\n\u003cli\u003eWen B, Zhang G, Zhan C, et al. The 2024 revision of the Declaration of Helsinki: a modern ethical framework for medical research[J]. Postgrad Med J,2025,101(1194):371-382.\u003c/li\u003e\n\u003cli\u003eMukherjee M, Rudski L G, Addetia K, et al. Guidelines for the Echocardiographic Assessment of the Right Heart in Adults and Special Considerations in Pulmonary Hypertension: Recommendations from the American Society of Echocardiography[J]. J Am Soc Echocardiogr,2025,38(3):141-186.\u003c/li\u003e\n\u003cli\u003eCossio-Aranda J, Zamora K D, Nanda N C, et al. Echocardiographic correlates of severe pulmonary hypertension in adult patients with ostium secundum atrial septal defect[J]. Echocardiography,2016,33(12):1891-1896.\u003c/li\u003e\n\u003cli\u003eZoghbi W A, Jone P N, Chamsi-Pasha M A, et al. Guidelines for the Evaluation of Prosthetic Valve Function With Cardiovascular Imaging: A Report From the American Society of Echocardiography Developed in Collaboration With the Society for Cardiovascular Magnetic Resonance and the Society of Cardiovascular Computed Tomography[J]. J Am Soc Echocardiogr,2024,37(1):2-63.\u003c/li\u003e\n\u003cli\u003eDoppler echocardiography \u0026ndash; Knowledge and References \u0026ndash; Taylor \u0026amp; Francis[Z]. 2025:2025.\u003c/li\u003e\n\u003cli\u003eRashidi F, Sate H, Mohammadi A, et al. Echocardiographic evaluation of prevalence of pulmonary hypertension in beta-thalassemia major: A cross sectional study[J]. Pediatr Hematol Oncol,2018,35(5-6):322-330.\u003c/li\u003e\n\u003cli\u003eD\u0026apos;Alto M, Bossone E, Opotowsky A R, et al. Strengths and weaknesses of echocardiography for the diagnosis of pulmonary hypertension[J]. Int J Cardiol,2018,263:177-183.\u003c/li\u003e\n\u003cli\u003eTopyla-Putowska W, Tomaszewski M, Wysokinski A, et al. Echocardiography in Pulmonary Arterial Hypertension: Comprehensive Evaluation and Technical Considerations[J]. J Clin Med,2021,10(15).\u003c/li\u003e\n\u003cli\u003eJankowich M, Maron B A, Choudhary G. Mildly elevated pulmonary artery systolic pressure on echocardiography: bridging the gap in current guidelines[J]. Lancet Respir Med,2021,9(10):1185-1191.\u003c/li\u003e\n\u003cli\u003eDong T X, Zhu Q, Wang S T, et al. Diagnostic and prognostic value of echocardiography in pulmonary hypertension: an umbrella review of systematic reviews and meta-analyses[J]. BMC Pulm Med,2023,23(1):253.\u003c/li\u003e\n\u003cli\u003eForrer A, Gaisl T, Sevik A, et al. Partial Pressure of Arterial Oxygen in Healthy Adults at High Altitudes: A Systematic Review and Meta-Analysis[J]. JAMA Netw Open,2023,6(6):e2318036.\u003c/li\u003e\n\u003cli\u003eMathew R, Huang J, Wu J M, et al. Hematological disorders and pulmonary hypertension[J]. World J Cardiol,2016,8(12):703-718.\u003c/li\u003e\n\u003cli\u003eHumbert M, Guignabert C, Bonnet S, et al. Pathology and pathobiology of pulmonary hypertension: state of the art and research perspectives[J]. Eur Respir J,2019,53(1).\u003c/li\u003e\n\u003cli\u003eSmolders V, Rodriguez C, Blanco I, et al. Metabolic profile in endothelial cells of chronic thromboembolic pulmonary hypertension and pulmonary arterial hypertension[J]. Sci Rep,2022,12(1):2283.\u003c/li\u003e\n\u003cli\u003eBousseau S, Sobrano F R, Gu S, et al. Pathophysiology and new advances in pulmonary hypertension[J]. BMJ Med,2023,2(1):e000137.\u003c/li\u003e\n\u003cli\u003eYang X, Liu H, Wu X. High-altitude pulmonary hypertension: a comprehensive review of mechanisms and management[J]. Clin Exp Med,2025,25(1):79.\u003c/li\u003e\n\u003cli\u003eVinci P, Di Girolamo F G, Panizon E, et al. Lipoprotein(a) as a Risk Factor for Cardiovascular Diseases: Pathophysiology and Treatment Perspectives[J]. Int J Environ Res Public Health,2023,20(18).\u003c/li\u003e\n\u003cli\u003eSammut M A, Condliffe R, Elliot C, et al. Atrial flutter and fibrillation in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension in the ASPIRE registry: Comparison of rate versus rhythm control approaches[J]. Int J Cardiol,2023,371:363-370.\u003c/li\u003e\n\u003cli\u003eLee D I, Kim S, Kang D O. Exploring the complex interplay between alcohol consumption and cardiovascular health: Mechanisms, evidence, and future directions[J]. Trends Cardiovasc Med,2025.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"High-altitude, Echocardiography, Hypoxic pulmonary hypertension (HPH), All-cause mortality, Risk factors","lastPublishedDoi":"10.21203/rs.3.rs-6055115/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6055115/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003eOver 80 million people reside above 2,500 meters, where hypobaric hypoxia elevates the risk of hypoxic pulmonary hypertension (HPH). In Qinghai, China (\u0026gt;3,000 m), over 5 million face a high HPH burden amid scarce medical resources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo assess risk factors and clinical correlates of HPH severity and mortality in high-altitude residents using echocardiography.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis retrospective study included 627 patients diagnosed with HPH (PASP ≥50 mmHg) via echocardiography at a tertiary hospital in Qinghai Province, China, from January 2018 to December 2022. Patients were categorized into moderate (50 ≤ PASP \u0026lt; 70 mmHg) and severe (PASP ≥70 mmHg) HPH groups. Clinical, biochemical, and echocardiographic data were collected, with mortality assessed via telephone follow-up after at least one year. Logistic regression identified factors associated with severe HPH, and Cox regression determined mortality predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eOf the 627 patients, 360 (57.4%) had moderate HPH and 267 (42.6%) had severe HPH. The severe HPH group exhibited lower albumin (33.50 ± 5.54 g/L vs. 35.45 ± 6.65 g/L, p \u0026lt; 0.001) and higher APTT (34.04 ± 7.48 s vs. 31.44 ± 6.91 s, p \u0026lt; 0.001), LPa (142.27 ± 126.64 mg/L vs. 110.67 ± 101.01 mg/L, p = 0.001), and rates of heart failure, cyanosis, and right ventricular hypertrophy (all p \u0026lt; 0.05). Logistic regression identified APTT (OR = 1.050, 95% CI: 1.014–1.087, p = 0.007), LPa (OR = 1.002, 95% CI: 1.001–1.004, p = 0.003), cyanosis (OR = 1.814, 95% CI: 1.235–2.663, p = 0.002), and right ventricular hypertrophy (OR = 3.501, 95% CI: 1.631–7.514, p = 0.001) as factors associated with severe HPH. Multivariate Cox regression identified LPa (HR = 3.461, 95% CI: 2.021–5.928, p \u0026lt; 0.001), atrial fibrillation (HR = 2.534, 95% CI: 1.365–4.705, p = 0.003), heart failure (HR = 2.316, 95% CI: 1.134–4.730, p = 0.021), and alcohol consumption (HR = 3.230, 95% CI: 1.277–8.171, p = 0.013) as mortality predictors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn high-altitude Qinghai residents, APTT, LPa, cyanosis, and right ventricular hypertrophy drive severe HPH, while LPa, atrial fibrillation, heart failure, and alcohol use predict mortality. Monitoring APTT and LPa may aid early detection, and managing modifiable factors like alcohol and atrial fibrillation could lower mortality in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"Risk Factors and Outcomes of HPH in High-Altitude Residents via echocardiographic evaluation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-31 06:38:02","doi":"10.21203/rs.3.rs-6055115/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-04-07T10:37:47+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-06T09:47:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-04T20:25:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-02T01:53:51+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-03-31T23:30:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87832259766867497176230670482409947839","date":"2025-03-31T22:06:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34741359034429974241783782743238215457","date":"2025-03-28T00:12:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"285935807846753469836434246226074877484","date":"2025-03-27T11:10:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94047117703063188780424564716477057811","date":"2025-03-27T04:04:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129410172346431591816477370515172733968","date":"2025-03-26T18:06:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-03-26T12:42:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-26T09:38:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-03-25T12:56:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fdffc027-07a4-4ad5-8be4-81ace1a76f04","owner":[],"postedDate":"March 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-04-10T11:08:07+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-31 06:38:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6055115","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6055115","identity":"rs-6055115","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}