Respiratory muscle strength in chronic heart failure

Several studies have suggested that the respiratory muscles are weak in patients with heart failure, but the aetiology and clinical relevance of this weakness are unclear. In order to see if respiratory muscle weakness in this context is part of a more generalised myopathic process, respiratory and limb muscle strength were compared in patients with heart failure. The relation between respiratory muscle strength, breathlessness on exercise, and exercise capacity was also examined.

Twenty patients (three women) with New York Heart Association (NYHA) class II-IV heart failure of mean age 63 years were studied. Respiratory muscle strength was assessed using maximum inspiratory and expiratory mouth pressures (MIP and MEP) and transdiaphragmatic pressure during sniffs (sniff PDI). These parameters were compared with cardiac output (indirect Fick) and with limb muscle strength as assessed by grip strength. The patients also performed two exercise tests during which they rated their breathlessness on a Borg scale.

Mean (SD) cardiac index was 2.2 (0.4) l/min/m2. MIP and MEP were 66 (27) and 99 (29) cm H2O respectively. Sniff PDI was 103 (21) cm H2O and was positively correlated with grip strength and cardiac output (Spearman rank correlation coefficients 0.527 and 0.451, respectively). None of the indices of respiratory muscle strength were related to exercise time or breathlessness during exercise.

The respiratory muscles are weak in patients with heart failure. This weakness reflects a more generalised myopathic process, possibly related to reduced cardiac output. However, respiratory muscle weakness does not appear to be an important factor in the aetiology of breathlessness on exercise.