Diaphragm Dysfunction after Cardiac Surgery: Insights from Ultrasound Imaging during Cardiac Rehabilitation

Area of Science:

• Cardiology
• Pulmonology
• Medical Imaging

Background:

• Diaphragm dysfunction frequently occurs post-cardiac surgery.
• Ultrasonography (US) is a non-invasive method for evaluating diaphragm function.

Purpose of the Study:

• To assess the incidence of diaphragmatic dysfunction after cardiac surgery.
• To evaluate the impact of cardiovascular rehabilitation (CR) on diaphragm function recovery.
• To identify predictors of diaphragmatic dysfunction and recovery failure.

Main Methods:

• A single-center cohort study involving 185 patients post-cardiac surgery.
• Diaphragm ultrasonography (US) and 6-minute walking test (6MWT) were performed at CR admission and after 10 sessions.
• Statistical analysis included odds ratios (OR) to identify risk factors and predictors.

Main Results:

• Diaphragm dysfunction was present in 70.8% of patients (131/185).
• Cardiovascular rehabilitation (CR) led to functional recovery in 68 patients.
• Combined surgery and post-operative pneumothorax increased the risk of diaphragm dysfunction recovery failure.
• Baseline diaphragm excursion and thickening fraction on US were strong predictors of functional recovery (aOR = 9.101, p < 0.001 and aOR = 1.058, p = 0.020, respectively).

Conclusions:

• Ultrasonography (US) is a valuable tool for assessing post-operative diaphragmatic dysfunction.
• US can identify patients at risk of diaphragm recovery failure after cardiac surgery.
• Diaphragm US parameters are more powerful predictors of recovery than 6MWT indexes.