Prevalence and prognosis of respiratory muscle weakness in heart failure patients with preserved ejection fraction

Hamazaki, Nobuaki; Kamiya, Kentaro; Matsuzawa, Ryota; Nozaki, Kohei; Ichikawa, Takafumi; Tanaka, Shinya; Nakamura, Takeshi; Maekawa, Emi; Noda, Chiharu; Yamaoka‐Tojo, Minako; Matsunaga, Atsuhiko; Masuda, Takashi; Ako, Junya

doi:10.1016/j.rmed.2019.105834

Cited by 22 publications

(19 citation statements)

References 30 publications

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“…To the best of our knowledge, this study is the first to demonstrate that the longitudinal change of respiratory muscle strength is a significant indicator of prognosis in patients with HF. Our previous study reported on the respiratory muscle strength as a significant predictor for prognosis in patients with HF with both reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) [7]. In general, decreased respiratory muscle strength is associated with reduced pulmonary function [6,21], a known risk factor for cardiovascular event including HF [22].…”

Section: Discussionmentioning

confidence: 99%

“…We also calculated percentage PI max (% PI max ) relative to the predictive value that was estimated using each age, gender, height, and body weight [17]. The % PI max of <70% was defined as respiratory muscle weakness based on previous reports in patients with HF [2,7,18].…”

Section: Pulmonary and Respiratory Muscle Functionsmentioning

confidence: 99%

“…The respiratory muscle weakness is caused by muscular atrophy and/or decreased number of cross-bridges, resulting from the activation of inflammatory and neuroendocrine factors due to HF [2][3][4][5]. Additionally, several studies have demonstrated that respiratory muscle weakness is an independent predictor of exercise intolerance, ventilatory inefficiency during exercise, and poor prognosis of patients with HF [6,7]. However, the influence of longitudinal changes in respiratory muscle strength on prognostic outcomes remains unclear.…”

Section: Introductionmentioning

confidence: 99%

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Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure

Hamazaki

Kamiya

Yamamoto

et al. 2020

JCM

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Respiratory muscle weakness, frequently observed in patients with heart failure (HF), is reported as a predictor for poor prognosis. Although increased respiratory muscle strength ameliorates exercise tolerance and quality of life in HF patients, the relationship between changes in respiratory muscle strength and patient prognosis remains unclear. A total of 456 patients with HF who continued a 5-month cardiac rehabilitation (CR) were studied. We measured maximal inspiratory pressure (PImax) at hospital discharge as the baseline and five months thereafter to assess the respiratory muscle strength. Changes in PImax during the 5-month observation period (⊿PImax) were examined. We investigated the composite multiple incidence of all-cause death or unplanned readmission after 5-month CR. The relationship between ⊿PImax and the incidence of clinical events was analyzed. Over a median follow-up of 1.8 years, 221 deaths or readmissions occurred, and their rate of incidence was 4.3/100 person-years. The higher ⊿PImax was significantly associated with lower incidence of clinical event. In multivariate Poisson regression model after adjustment for clinical confounding factors, ⊿PImax remained a significant and independent predictor for all-cause death/readmission (adjusted incident rate ratio for ⊿PImax increase of 10 cmH2O: 0.77, 95% confidence interval: 0.70–0.86). In conclusion, the changes in respiratory muscle strength independently predict the incidence of clinical events in patients with HF.

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Section: Discussionmentioning

confidence: 99%

Section: Pulmonary and Respiratory Muscle Functionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure

Hamazaki

Kamiya

Yamamoto

et al. 2020

JCM

Self Cite

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“…Inspiratory (i.e. diaphragm) muscle weakness is evident and closely associated with symptoms of dyspnoea and poor prognosis in patients with HFpEF (Lavietes et al 2004;Hamazaki et al 2020). Multiple alterations to the diaphragm have been reported in HFpEF, including in vitro muscle weakness and fatigue alongside a Type II-to-I fibre-type shift, fibre atrophy, and impaired in situ mitochondrial respiration in a hypertensive rat model (Bowen et al 2015).…”

Section: Impact Of Hfpef On Diaphragm Remodelling and Muscle Mechanicsmentioning

confidence: 99%

Abnormal skeletal muscle blood flow, contractile mechanics and fibre morphology in a rat model of obese‐HFpEF

Espino-González

Tickle

Benson

et al. 2021

The Journal of Physiology

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Heart failure is characterised by limb and respiratory muscle impairments that limit functional capacity and quality of life. However, compared with heart failure with reduced ejection fraction (HFrEF), skeletal muscle alterations induced by heart failure with preserved ejection fraction (HFpEF) remain poorly explored. r Here we report that obese-HFpEF induces multiple skeletal muscle alterations in the rat hindlimb, including impaired muscle mechanics related to shortening velocity, fibre atrophy, capillary loss, and an impaired blood flow response to contractions that implies a perfusive oxygen delivery limitation. r We also demonstrate that obese-HFpEF is characterised by diaphragmatic alterations similar to those caused by denervation-atrophy in Type IIb/IIx (fast/glycolytic) fibres and hypertrophy in Type I (slow/oxidative) fibres. r These findings extend current knowledge in HFpEF skeletal muscle physiology, potentially underlying exercise intolerance, which may facilitate future therapeutic approaches.

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“…Several studies have examined the link between respiratory muscle strength and dyspnea and their effect on exercise intolerance among patients with CHF [6][7][8][9][10]. However, these studies have yielded controversial findings, due to the heterogeneity of their samples and their methods of exercise capacity and respiratory muscle strength assessment.…”

Section: Introductionmentioning

confidence: 99%

Exercise Capacity Is Independent of Respiratory Muscle Strength in Patients with Chronic Heart Failure

Albarrati

Aseeri²,

Taher

et al. 2022

JCM

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Background: Exercise intolerance in patients with chronic heart failure (CHF) is associated with a number of factors, including breathlessness and respiratory muscle weakness. However, many studies reported controversial results, and as yet there is no study on Arabic patients with CHF. This study aimed to examine the impact of breathlessness and respiratory muscle strength on exercise capacity in Arabic patients with CHF. Methods: This was a cross-sectional study, involving 42 stable adult male patients with CHF with a reduced ejection fraction and 42 controls who were free from cardiorespiratory and neuromuscular diseases. Patients with CHF and the controls underwent respiratory muscle strength tests and a six-minute walk test (6MWT), and the measurements were taken. Dyspnea was recorded using the modified Medical Research Council (mMRC) scale, along with the number of comorbidities. Results: Patients with CHF and controls were similar in age and sex. Patients with CHF had a greater number of comorbidities, a higher dyspnea score, a lower 6MWT score, and lower respiratory muscle strength (p < 0.001). Only 7% of patients with CHF had weak inspiratory muscle strength (<60% of that predicted) and 40% terminated the 6MWT due to dyspnea. The 6MWT was associated with mMRC (rs = −0.548, p < 0.001) but not with respiratory muscle strength (p > 0.05). Conclusions: Exercise intolerance in patients with CHF was associated with dyspnea and was independent of respiratory muscle strength.

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Prevalence and prognosis of respiratory muscle weakness in heart failure patients with preserved ejection fraction

Cited by 22 publications

References 30 publications

Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure

Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure

Abnormal skeletal muscle blood flow, contractile mechanics and fibre morphology in a rat model of obese‐HFpEF

Exercise Capacity Is Independent of Respiratory Muscle Strength in Patients with Chronic Heart Failure

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