Cardiac changes induced by immersion and breath-hold diving in humans

1 Unità Operativa Cardiovascolare-Utic Ospedale di Cecina (Livorno), Padua; 2 Consiglio Nazionale delle Ricerca Institute of Clinical Physiology, Pisa; 3 Apnea Academy Research, Padua; and 4 Scuola Superiore Sant'Anna, Pisa, Italy Submitted 4 February 2008 ; accepted in final form 7 May 2008 To evaluate the separate cardiovascular response to body immersion and increased environmental pressure during diving, 12 healthy male subjects (mean age 35.2 ± 6.5 yr) underwent two-dimensional Doppler echocardiography in five different conditions: out of water (basal); head-out immersion while breathing ( condition A ); fully immersed at the surface while breathing ( condition B ) and breath holding ( condition C ); and breath-hold diving at 5-m depth ( condition D ). Heart rate, left ventricular volumes, stroke volume, and cardiac output were obtained by underwater echocardiography. Early (E) and late (A) transmitral flow velocities, their ratio (E/A), and deceleration time of E (DTE) were also obtained from pulsed-wave Doppler, as left ventricular diastolic function indexes. The experimental protocol induced significant reductions in left ventricular volumes, left ventricular stroke volume ( P < 0.05), cardiac output ( P < 0.001), and heart rate ( P < 0.05). A significant increase in E peak ( P < 0.01) and E/A ( P < 0.01) and a significant reduction of DTE ( P < 0.01) were also observed. Changes occurring during diving ( condition D ) accounted for most of the changes observed in the experimental series. In particular, cardiac output at condition D was significantly lower compared with each of the other experimental conditions, E/A was significantly higher during condition D than in conditions A and C . Finally, DTE was significantly shorter at condition D than in basal and condition C . This study confirms a reduction of cardiac output in diving humans. Since most of the changes were observed during diving, the increased environmental pressure seems responsible for this hemodynamic rearrangement. Left ventricular diastolic function changes suggest a constrictive effect on the heart, possibly accounting for cardiac output reduction. diving response; hemodynamics Address for reprint requests and other correspondence: C. Marabotti, UO Cardiovascolare-UTIC, Ospedale di Cecina, Via Montanara, 57023 Cecina (LI), Italy (e-mail: maralbian{at}alice.it )