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Related Experiment Videos

Diaphragm strength in chronic heart failure.

P D Hughes1, M I Polkey, M L Harrus

  • 1Department of Cardiology and Respiratory Muscle Laboratory, Royal Brompton Hospital and National Heart and Lung Institute, London, UK.

American Journal of Respiratory and Critical Care Medicine
|August 3, 1999
PubMed
Summary

Respiratory muscle strength is generally preserved in chronic heart failure (CHF). However, diaphragm strength is mildly reduced in CHF patients, as shown by specific measurements.

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Area of Science:

  • Cardiology
  • Pulmonology
  • Respiratory Physiology

Background:

  • Reduced respiratory muscle strength is a known complication in chronic heart failure (CHF).
  • Previous assessments relied heavily on maximal mouth pressures (MIP, MEP), which are effort-dependent and difficult for some patients.
  • There is a need for more reliable methods to assess respiratory muscle function, particularly diaphragm strength, in CHF.

Purpose of the Study:

  • To evaluate respiratory muscle strength in CHF patients using methods less dependent on patient effort.
  • To specifically assess diaphragm strength using non-volitional maneuvers and phrenic nerve stimulation.
  • To compare diaphragm strength in CHF patients with healthy controls.

Main Methods:

  • Measured maximal inspiratory and expiratory mouth pressures (MIP, MEP).

Related Experiment Videos

  • Assessed esophageal and transdiaphragmatic pressures during maximal sniffs (Sn Pes, Sn Pdi).
  • Utilized cervical magnetic phrenic nerve stimulation (Tw Pdi) and paired stimulation (pTw Pdi) to assess diaphragm contractility.

    • Main Results:

    • MIP was significantly reduced in CHF patients compared to controls (p=0.01).
    • Diaphragm strength, measured by Sn Pdi (p=0.04) and Tw Pdi (p=0.0005), was significantly reduced in CHF.
    • Sn Pes and MEP showed non-significant trends towards reduction in CHF patients.

    Conclusions:

    • Chronic heart failure is associated with a mild reduction in diaphragm strength.
    • This reduction may be linked to an increased proportion of slow muscle fibers in the diaphragm.
    • Overall respiratory muscle strength is largely preserved in CHF, despite specific diaphragm weakness.