Am. J. Respir. Crit. Care Med., Volume 160, Number 2, August 1999, 529-534

Diaphragm Strength In Chronic Heart Failure

PHILIP D. HUGHES, MICHAEL I. POLKEY, M. LOU HARRIS, ANDREW J. S. COATS, JOHN MOXHAM, and MALCOLM GREEN

Department of Cardiology and Respiratory Muscle Laboratory, Royal Brompton Hospital and National Heart and Lung Institute, London; and Respiratory Muscle Laboratory, Kings College Hospital, London, United Kingdom

Reduced respiratory muscle strength has been reported in chronic heart failure (CHF) in several studies. The data supporting this conclusion come almost exclusively from static inspiratory and expiratory mouth pressure maneuvers (MIP, MEP), which many subjects find difficult to perform. We therefore performed a study using measurements that are less dependent on patient aptitude and also provide specific data on diaphragm strength. In 20 male patients and 15 control subjects we measured MIP and MEP as well as esophageal and transdiaphragmatic pressure during maximal sniffs (Sn Pes, Sn Pdi) and cervical magnetic phrenic nerve stimulation (Tw Pdi). In a subgroup the response to paired phrenic nerve stimulation (pTw Pdi) at interpulse intervals from 10 to 200 ms (5 to 100 Hz) was also determined. As expected, MIP was significantly reduced in the CHF group (CHF, 69.5 cm H₂O; control, 96.7 cm H₂O; p = 0.01), but differences were much less marked for Sn Pes (CHF, 95.2 cm H₂O; control, 104.8 cm H₂O; p = 0.20) and MEP (CHF, 109.1 cm H₂O; control, 135.7 cm H₂O; p = 0.09). Diaphragm strength was significantly reduced (Sn Pdi: CHF, 123.8 cm H₂O; control 143.5 cm H₂O; p = 0.04. Tw Pdi: CHF, 21.4 cm H₂O; control, 28.5 cm H₂O; p = 0.0005). Paired phrenic nerve stimulation suggested a trend to increased twitch summation at 5 to 20 Hz in CHF, although this did not reach significance. We conclude that mild reduction in diaphragm strength occurs in CHF, possibly because of an increased proportion of slow fibers, but overall strength of the respiratory muscles remains well preserved.

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