PMID- 33171473 OWN - NLM STAT- MEDLINE DCOM- 20211110 LR - 20211110 IS - 1423-0356 (Electronic) IS - 0025-7931 (Linking) VI - 100 IP - 2 DP - 2021 TI - Heart Failure Results in Inspiratory Muscle Dysfunction Irrespective of Left Ventricular Ejection Fraction. PG - 96-108 LID - 10.1159/000509940 [doi] AB - BACKGROUND: Exercise intolerance in heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF) results from both cardiac dysfunction and skeletal muscle weakness. Respiratory muscle dysfunction with restrictive ventilation disorder may be present irrespective of left ventricular ejection fraction and might be mediated by circulating pro-inflammatory cytokines. OBJECTIVE: To determine lung and respiratory muscle function in patients with HFrEF/HFpEF and to determine its associations with exercise intolerance and markers of systemic inflammation. METHODS: Adult patients with HFrEF (n = 22, 19 male, 61 +/- 14 years) and HFpEF (n = 8, 7 male, 68 +/- 8 years) and 19 matched healthy control subjects underwent spirometry, measurement of maximum mouth occlusion pressures, diaphragm ultrasound, and recording of transdiaphragmatic and gastric pressures following magnetic stimulation of the phrenic nerves and the lower thoracic nerve roots. New York Heart Association (NYHA) class and 6-min walking distance (6MWD) were used to quantify exercise intolerance. Levels of circulating interleukin 6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) were measured using ELISAs. RESULTS: Compared with controls, both patient groups showed lower forced vital capacity (FVC) (p < 0.05), maximum inspiratory pressure (PImax), maximum expiratory pressure (PEmax) (p < 0.05), diaphragm thickening ratio (p = 0.01), and diaphragm strength (twitch transdiaphragmatic pressure in response to supramaximal cervical magnetic phrenic nerve stimulation) (p = 0.01). In patients with HFrEF, NYHA class and 6MWD were both inversely correlated with FVC, PImax, and PEmax. In those with HFpEF, there was an inverse correlation between amino terminal pro B-type natriuretic peptide levels and FVC (r = -0.77, p = 0.04). In all HF patients, IL-6 and TNF-alpha were statistically related to FVC. CONCLUSIONS: Irrespective of left ventricular ejection fraction, HF is associated with respiratory muscle dysfunction, which is associated with increased levels of circulating IL-6 and TNF-alpha. CI - (c) 2020 S. Karger AG, Basel. FAU - Spiesshoefer, Jens AU - Spiesshoefer J AD - Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy, jspiesshoefe@ukaachen.de. AD - Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany, jspiesshoefe@ukaachen.de. AD - Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany, jspiesshoefe@ukaachen.de. FAU - Henke, Carolin AU - Henke C AD - Department of Neurology, Herz-Jesu-Krankenhaus Hiltrup, Muenster, Germany. FAU - Kabitz, Hans Joachim AU - Kabitz HJ AD - Department of Pneumology, Cardiology and Intensive Care Medicine, Klinikum Konstanz, Konstanz, Germany. FAU - Bengel, Philipp AU - Bengel P AD - Clinic for Cardiology and Pneumology/Heart Center, University Medical Center Goettingen, DZHK (German Centre for Cardiovascular Research), Goettingen, Germany. FAU - Schutt, Katharina AU - Schutt K AD - Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany. FAU - Nofer, Jerzy-Roch AU - Nofer JR AD - Center for Laboratory Medicine, University Hospital Muenster, University of Muenster, Muenster, Germany and Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. FAU - Spieker, Maximilian AU - Spieker M AD - Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Dusseldorf, Heinrich Heine University Dusseldorf, Dusseldorf, Germany. FAU - Orwat, Stefan AU - Orwat S AD - Department of Cardiology III, University Hospital Muenster, Muenster, Germany. FAU - Diller, Gerhard Paul AU - Diller GP AD - Department of Cardiology III, University Hospital Muenster, Muenster, Germany. FAU - Strecker, Jan Kolia AU - Strecker JK AD - Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany. FAU - Giannoni, Alberto AU - Giannoni A AD - Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy. FAU - Dreher, Michael AU - Dreher M AD - Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany. FAU - Randerath, Winfried Johannes AU - Randerath WJ AD - Institute for Pneumology at the University of Cologne, Solingen, Germany. AD - Bethanien Hospital gGmbH Solingen, Solingen, Germany. FAU - Boentert, Matthias AU - Boentert M AD - Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany. AD - Department of Medicine, UKM Marienhospital Steinfurt, Steinfurt, Germany. FAU - Tuleta, Izabela AU - Tuleta I AD - Department of Cardiology I, University Hospital Muenster, Muenster, Germany. LA - eng PT - Journal Article DEP - 20201110 PL - Switzerland TA - Respiration JT - Respiration; international review of thoracic diseases JID - 0137356 RN - 0 (Interleukin-6) RN - 0 (Tumor Necrosis Factor-alpha) SB - IM MH - Aged MH - Case-Control Studies MH - Cross-Sectional Studies MH - Diaphragm/diagnostic imaging MH - Exercise Tolerance/physiology MH - Female MH - Heart Failure/blood/complications/*physiopathology MH - Humans MH - Interleukin-6/blood MH - Lung/physiopathology MH - Male MH - Maximal Respiratory Pressures MH - Middle Aged MH - Muscle Strength/physiology MH - Respiration Disorders/*etiology/physiopathology MH - Respiratory Muscles/*physiopathology MH - Stroke Volume/*physiology MH - Tumor Necrosis Factor-alpha/blood MH - Ultrasonography MH - Vital Capacity OTO - NOTNLM OT - Diaphragm OT - Heart failure OT - Interleukin-6 OT - Muscle strength OT - Tumor necrosis factor-alpha EDAT- 2020/11/11 06:00 MHDA- 2021/11/11 06:00 CRDT- 2020/11/10 20:15 PHST- 2020/03/10 00:00 [received] PHST- 2020/07/04 00:00 [accepted] PHST- 2020/11/11 06:00 [pubmed] PHST- 2021/11/11 06:00 [medline] PHST- 2020/11/10 20:15 [entrez] AID - 000509940 [pii] AID - 10.1159/000509940 [doi] PST - ppublish SO - Respiration. 2021;100(2):96-108. doi: 10.1159/000509940. Epub 2020 Nov 10.