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Am. J. Respir. Crit. Care Med., Volume 163, Number 6, May 2001, 1400-1403

Inspiratory Muscle Relaxation Rate Slows during Exhaustive Treadmill Walking in Patients with Chronic Heart Failure

PHILIP D. HUGHES, NICHOLAS HART, CARL-HUGO HAMNEGÅRD, MALCOLM GREEN, ANDREW J. S. COATS, JOHN MOXHAM, and MICHAEL I. POLKEY

Respiratory Muscle Laboratory and Department of Cardiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College School of Medicine; Respiratory Muscle Laboratory, Denmark Hill Campus, Guy's, King's and St Thomas's School of Medicine, London, United Kingdom; and Department of Pulmonary Medicine, Sahlgrenska University Hospital, Göteborg, Sweden

Exercise intolerance is a feature of chronic heart failure (CHF). We hypothesized that excessive loading of the respiratory muscle pump might contribute to exertional breathlessness. One marker of excessive muscle-loading is slowing of maximum relaxation rate (MRR) and, therefore, to test our hypothesis, we investigated the effect of exhaustive treadmill walking on inspiratory muscle MRR in patients with CHF. We studied eight stable patients with mild-moderate CHF walking on a treadmill until termination because of severe dyspnea. Inspiratory muscle MRR was determined from esophageal pressure (Pes) change during submaximal sniffs (Sn) before and immediately after exercise to a mean (SD) minute ventilation of 77 () L/min. For comparison, nine healthy subjects performed a similar protocol; exercise was terminated either by severe dyspnea or when minute ventilation reached 100 L/min. There were no significant differences in terms of heart rate, respiratory rate, tidal volume, or inspiratory duty cycle at cessation of exercise. The mean slowing of Sn Pes MRR in the first minute after termination of exercise in the CHF group was 22.4% and in the normal control group it was 2.8% (p < 0.01). Our data show that slowing of inspiratory muscle relaxation rate occurs in patients with CHF walking to severe breathlessness. We conclude that severe loading of the inspiratory muscles is a feature of exertional dyspnea in CHF.




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