Diaphragm Muscle Dysfunction in Patients With Heart Failure

Miyagi, Mari; Kinugasa, Yoshiharu; Sota, Takeshi; Yamada, Kensaku; Ishisugi, Takuya; Hirai, Masayuki; Yanagihara, Kiyotaka; Haruki, Nobuhiko; Matsubara, Koichi; Kato, Masahiko; Yamamoto, Kazuhide

doi:10.1016/j.cardfail.2017.12.004

Cited by 48 publications

(56 citation statements)

References 27 publications

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“…11,12 Patients' medical records were retrospectively reviewed to obtain information on demographics, medical history, co-morbidities, laboratory data, echocardiographic findings, treatments, cause of death, and conversations about lifesustaining treatments. Of these, 818 patients who were discharged alive from our hospital were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…HF was defined according to the Framingham Criteria, as previously described. 11,12 Patients' medical records were retrospectively reviewed to obtain information on demographics, medical history, co-morbidities, laboratory data, echocardiographic findings, treatments, cause of death, and conversations about lifesustaining treatments. The severity of HF was assessed using the Acute Decompensated Heart Failure National Registry (ADHERE) algorithm, as previously described.…”

Section: Methodsmentioning

confidence: 99%

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Sex differences in surrogate decision‐maker preferences for life‐sustaining treatments of Japanese patients with heart failure

et al. 2018

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AimsPatients with end‐stage heart failure (HF) often require surrogate decision making for end‐of‐life care owing to a lack of decision‐making capacity. However, the clinical characteristics of surrogate decision making for life‐sustaining treatments in Japan remain to be investigated.Methods and resultsAmong 934 patients admitted to our hospital for HF from January 2004 to December 2015, we retrospectively reviewed the medical records of consecutive 106 patients who died in hospital (mean age 73 ± 13 years; male, 52.6%). During hospitalization, attending physicians conducted an average of 2.1 ± 1.4 end‐of‐life conversations with patients and/or their families. Only 4.7% of patients participated in the conversations and declared their preferences; surrogates made medical care decisions in 95.3% of cases. Most decisions by surrogates (98.1%) were made without the patient's advance directive. During initial end‐of‐life conversations, 49.4% of surrogates requested cardiopulmonary resuscitation (CPR). However, 72.0% of CPR preferences were changed to do not attempt resuscitation (DNAR) orders in the final conversation. Female surrogates were more likely to change the preference from CPR to DNAR than were male surrogates (47.1% vs. 25.0%, P = 0.023).ConclusionsCompared with male surrogates, female surrogates wavered more often in their decisions regarding life‐sustaining treatments of Japanese patients with end‐stage HF.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Sex differences in surrogate decision‐maker preferences for life‐sustaining treatments of Japanese patients with heart failure

et al. 2018

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“…As a noninvasive bedside tool, diaphragm ultrasound has been used in a variety of diseases and settings [1][2][3]. These include patients with neuromuscular disorders [2] and, more recently, patients with heart failure [8]. In addition, diaphragm ultrasound has been applied in chronic pulmonary disease [9][10][11], and ultrasound measures of diaphragmatic dysfunction have been shown to correlate with morbidity and poor prognosis in mechanically ventilated patients and in patients with chronic obstructive pulmonary disease (COPD) [12][13][14].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Respiratory Muscle Strength and Diaphragm Ultrasound: Normative Values, Theoretical Considerations, and Practical Recommendations

et al. 2020

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Background: Reference values derived from existing diaphragm ultrasound protocols are inconsistent, and the association between sonographic measures of diaphragm function and volitional tests of respiratory muscle strength is still ambiguous. Objective: To propose a standardized and comprehensive protocol for diaphragm ultrasound in order to determine lower limits of normal (LLN) for both diaphragm excursion and thickness in healthy subjects and to explore the association between volitional tests of respiratory muscle strength and diaphragm ultrasound parameters. Methods: Seventy healthy adult subjects (25 men, 45 women; age 34 ± 13 years) underwent spirometric lung function testing, determination of maximal inspiratory and expiratory pressure along with ultrasound evaluation of diaphragm excursion and thickness during tidal breathing, deep breathing, and maximum voluntary sniff. Excursion data were collected for amplitude and velocity of diaphragm displacement. Diaphragm thickness was measured in the zone of apposition at total lung capacity (TLC) and functional residual capacity (FRC). All participants underwent invasive measurement of transdiaphragmatic pressure (Pdi) during different voluntary breathing maneuvers. Results: Ultrasound data were successfully obtained in all participants (procedure duration 12 ± 3 min). LLNs (defined as the 5th percentile) for diaphragm excursion were as follows: (a) during tidal breathing: 1.2 cm (males; M) and 1.2 cm (females; F) for amplitude, and 0.8 cm/s (M) and 0.8 cm/s (F) for velocity, (b) during maximum voluntary sniff: 2.0 cm (M) and 1.5 cm (F) for amplitude, and 6.7 (M) cm/s and 5.2 cm/s (F) for velocity, and (c) at TLC: 7.9 cm (M) and 6.4 cm (F) for amplitude. LLN for diaphragm thickness was 0.17 cm (M) and 0.15 cm (F) at FRC, and 0.46 Spiesshoefer et al. cm (M) and 0.35 cm (F) at TLC. Values for males were consistently higher than for females, independent of age. LLN for diaphragmatic thickening ratio was 2.2 with no difference between genders. LLN for invasively measured Pdi during different breathing maneuvers are presented. Voluntary Pdi showed only weak correlation with both diaphragm excursion velocity and amplitude during forced inspiration. Conclusions: Diaphragm ultrasound is an easy-to-perform and reproducible diagnostic tool for noninvasive assessment of diaphragm excursion and thickness. It supplements but does not replace respiratory muscle strength testing.

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“…In this issue of Journal of Cardiac Failure, Miyagi and colleagues [8] provide further evidence supporting the clinical significance of diaphragm dysfunction in patients with HF. In a detailed, retrospective study, the authors obtained ultrasonography derived measures of diaphragm muscle thickness in 77 patients (final sample size) hospitalised with a primary diagnosis of HF.…”

Section: Takedownmentioning

confidence: 94%

“…To answer our first question; Miyagi et al [8] evaluate inspiratory muscle function using spirometry and diaphragm muscle ultrasound routinely as part of the standard rehabilitation program for HF patients hospitalised at their facility. However, in our experience, the use of ultrasound to assess inspiratory muscle function is far from standard practice in the vast majority of clinics.…”

Section: Takedownmentioning

confidence: 99%

Respiratory Muscle Weakness in Patients with Heart Failure: Time to Make It a Standard Clinical Marker and a Need for Novel Therapeutic Interventions?

Taylor

Bowen

2018

Journal of Cardiac Failure

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Diaphragm Muscle Dysfunction in Patients With Heart Failure

Cited by 48 publications

References 27 publications

Sex differences in surrogate decision‐maker preferences for life‐sustaining treatments of Japanese patients with heart failure

Sex differences in surrogate decision‐maker preferences for life‐sustaining treatments of Japanese patients with heart failure

Evaluation of Respiratory Muscle Strength and Diaphragm Ultrasound: Normative Values, Theoretical Considerations, and Practical Recommendations

Respiratory Muscle Weakness in Patients with Heart Failure: Time to Make It a Standard Clinical Marker and a Need for Novel Therapeutic Interventions?

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