Chest
Volume 105, Issue 2, February 1994, Pages 355-359
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Clinical Investigations
Cardiology
Respiratory Muscle Strength and Hemodynamics in Chronic Heart Failure

https://doi.org/10.1378/chest.105.2.355Get rights and content

To examine whether respiratory muscle weakness is associated with cardiac function and/or exercise capacity in chronic heart failure (CHF), 23 patients with CHF were evaluated with respiratory muscle strength, pulmonary function tests, cardiac catheterization, and exercise test The subjects were divided into three groups on their New York Heart Association (NYHA) functional class. Group A consisted of 13 patients with NYHA functional classification class 3 or 4, group B consisted of 10 patients with NYHA classification dass 2, and group C consisted of 15 age-matched normal controls. Respiratory muscle strength was assessed with maximal static inspiratory mouth pressure at residual volume level and expiratory mouth pressure at total lung capacity level (Pimax, PEmax, respectively). Pulmonary functions in patients with CHF showed almost normal. Pimax in group A was significantly less than that in group B or C, although Pimax in group B was not significantly different from that in group C. In the patients with CHF, Pimax correlated positively with cardiac index and maximal oxygen consumption ( r=0.460 and r=0.503, p < 0.05, respectively). These findings suggest that inspiratory muscle strength, which was impaired in patients with severe CHF, may be dependent on cardiac function and may be one of the limiting factors on impaired exercise capacity in the patients with CHF.

Section snippets

Patient Population

We studied 23 patients with CHF (18 male and 5 female, mean age ± SD, 59.3 ± 9.2 years) and 15 age-matched healthy volunteers (12 male and 3 female, 60.2 ± 6.2 years). Patients with CHF consisted of seven with old myocardial infarction, eight with old myocardial infarction and angina pectoris, four with mitral valve disease, and four with dilated cardiomyopathy (Table 1). Each patient was examined while in a stable hemodynamic condition and free of acute exacerbation, although all the patients

Results

The anthropometric data are shown in Table 2. Ages were not significantly different among group A, group B, and controls. Height and body weight did not differ significantly among three groups. Plasma albumin level in group A was not significantly lower than that in group B (3.7 ± 0.2 and 3.9 ± 0.3 g/dl, respectively). Six of 13 patients with group A and 2 of 10 patients with group B showed myocardial ischemic response during exercise test.

Mean values of pulmonary function variables showed

Discussion

We have demonstrated that respiratory muscle strength exhibited reduction in patients with severe CHF and that the impairment in inspiratory muscle strength was intimately related to the deterioration in cardiac function and to the impaired exercise capacity. This may support our hypothesis that, if respiratory muscle strength is dependent on the cardiac dysfunction, the patients with CHF should exhibit respiratory muscle weakness related to cardiac output.

Our present study showed that patients

ACKNOWLEDGMENT

The authors thank H. Yamabe, M.D., and A. Hashimoto, M.D., for invaluable help in exercise data collection.

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