Diaphragmatic ultrasound evaluation in acute heart failure: clinical and functional associations
Internal and Emergency Medicine - Trang 1-7 - 2024
Tóm tắt
Heart failure patients often experience respiratory symptoms due to diaphragmatic involvement, but the diaphragmatic motion in heart failure remains understudied. This research aimed to investigate the correlation between ultrasonographically assessed diaphragmatic motion and thickness with cardiac performance indexes in an emergency setting. Seventy-two acutely decompensated heart failure patients and 100 non-heart failure individuals were enrolled. Diaphragmatic motion and thickness were assessed via ultrasound. Cardiac and respiratory parameters were recorded, and regression analysis was performed. Heart failure patients exhibited reduced diaphragmatic motion at total lung capacity compared to controls, and an inverse association was found between motion and heart failure severity (NYHA stage). Diaphragmatic thickness was also higher in heart failure patients at tidal volume and total lung capacity. Notably, diaphragmatic motion inversely correlated with systolic pulmonary artery pressure. The study highlights diaphragmatic dysfunction in acutely decompensated heart failure, with reduced motion and increased thickness. These changes were associated with cardio-respiratory parameters, specifically systolic pulmonary artery pressure. Monitoring diaphragmatic motion via ultrasound may aid in evaluating heart failure severity and prognosis in emergency settings. Additionally, interventions targeting diaphragmatic function could improve heart failure management. Further research is warranted to enhance heart failure management and patient outcomes.
Tài liệu tham khảo
McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A; ESC Scientific Document Group (2021) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021(42):3599–3726
Olson TP, Beck KC, Johnson JB, Johnson BD (2006) Competition for intrathoracic space reduces lung capacity in patients with chronic heart failure: a radiographic study. Chest 130:164–171
Verissimo P, Timenetsky KT, Casalaspo TJA, Gonçalves LHR, Yang ASY, Eid RC (2015) High prevalence of respiratory muscle weakness in hospitalized acute heart failure elderly patients. PLoS ONE 10(2):e0118218
Lena A, Anker MS, Springer J (2020) Muscle wasting and sarcopenia in heart failure—the current state of science. Int J Mol Sci 21:6549
Miyagi M, Kinugasa Y, Sota T, Yamada K, Ishisugi T, Hirai M, Yanagihara K, Haruki N, Matsubara K, Kato M, Yamamoto K (2018) Diaphragm muscle dysfunction in patients with heart failure. J Card Fail 24:209–216
Kinugasa Y, Miyagi M, Sota T, Yamada K, Ishisugi T, Hirai M, Yanagihara K, Haruki N, Matsubara K, Kato M, Yamamoto K (2018) Dynapenia and diaphragm muscle dysfunction in patients with heart failure. Eur J Prev Cardiol 25:1785–1786
Spiesshoefer J, Henke C, Kabitz HJ, Bengel P, Schütt K, Nofer JR, Spieker M, Orwat S, Diller GP, Strecker JK, Giannoni A, Dreher M, Randerath WJ, Boentert M, Tuleta I (2021) Heart failure results in inspiratory muscle dysfunction irrespective of left ventricular ejection fraction. Respiration 100:96–108
Scarlata S, Mancini D, Laudisio A, Raffaele AI (2019) Reproducibility of diaphragmatic thickness measured by M-mode ultrasonography in healthy volunteers. Respir Physiol Neurobiol 260:58–62
Scarlata S, Mancini D, Laudisio A, Benigni A, Antonelli Incalzi R (2018) Reproducibility and clinical correlates of supine diaphragmatic motion measured by M-mode ultrasonography in healthy volunteers. Respiration 96:259–266
Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 28:1–39
Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, International Liaison Committee on Lung Ultrasound (ILC-LUS) for the International Consensus Conference on Lung Ultrasound (ICC-LUS) (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591
Kelley RC, Ferreira LF (2017) Diaphragm abnormalities in heart failure and aging: mechanisms and integration of cardiovascular and respiratory pathophysiology. Heart Fail Rev 22:191–207
Arutyunov AG, Ilyina KV, Arutyunov GP, Kolesnikova EA, Pchelin VV, Kulagina NP, Tokmin DS, Tulyakova EV (2019) Morphofunctional features of the diaphragm in patients with chronic heart failure. Kardiologiia 59:12–21
Mangner N, Garbade J, Heyne E, van den Berg M, Winzer EB, Hommel J, Sandri M, Jozwiak-Nozdrzykowska J, Meyer AL, Lehmann S, Schmitz C, Malfatti E, Schwarzer M, Ottenheijm CAC, Bowen TS, Linke A, Adams V (2021) Molecular mechanisms of diaphragm myopathy in humans with severe heart failure. Circ Res 128(6):706–719
Mantilla CB, Sieck GC (2003) Plasticity in respiratory motor control. Invited review: mechanisms underlying motor unit plasticity in the respiratory system. J Appl Physiol 94:1230–1241
Manders E, Rain S, Bogaard HJ, Handoko ML, Stienen GJ, Vonk-Noordegraaf A, Ottenheijm CA, de Man FS (2015) The striated muscles in pulmonary arterial hypertension: adaptations beyond the right ventricle. Eur Respir J 46:832–842
Manders E, Bonta PI, Kloek JJ, Symersky P, Bogaard HJ, Hooijman PE, Jasper JR, Malik FI, Stienen GJ, Vonk-Noordegraaf A, de Man FS, Ottenheijm CA (2016) Reduced force of diaphragm muscle fibers in patients with chronic thromboembolic pulmonary hypertension. Am J Physiol Lung Cell Mol Physiol 311(1):L20–L28
Jorbenadze A, Goldberg LR, Shaburishvili T, Zuber M, Mirro M, Fudim M (2022) Synchronized diaphragmatic stimulation for heart failure with a reduced left ventricular ejection fraction using the VisONE system: a first-in-patient study with extended population. Struct Heart 6(6):100103
Zuber M, Roos M, Kobza R, Toggweiler S, Meier R, Erne P (2010) Detection and hemodynamic significance of cardiac pacemaker-induced phrenic nerve stimulation. Congest Heart Fail 16:147–152
Fudim M, Abraham WT, von Bardeleben RS et al (2021) Device therapy in chronic heart failure: JACC state-of-the-art review. J Am Coll Cardiol 78(9):931–956
Gargani L, Girerd N, Platz E, Pellicori P, Stankovic I, Palazzuoli A, Pivetta E, Miglioranza MH, Soliman-Aboumarie H, Agricola E, Volpicelli G, Price S, Donal E, Cosyns B, Neskovic AN (2023) Lung ultrasound in acute and chronic heart failure. A clinical consensus statement of the european association of cardiovascular imaging (EACVI). Eur Heart J Cardiovasc Imaging 24:169