P2625Pathophysiology of diaphragm involvement in systolic heart failure: insights from diaphragm ultrasound and phrenic nerve stimulation studies

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Spiesshoefer ◽  
I T Tuleta ◽  
A G Giannoni ◽  
M B Boentert
Keyword(s):  
Heart Failure ◽  
Phrenic Nerve ◽  
Systolic Heart Failure ◽  
Exercise Intolerance ◽  
Design Data ◽  
Diaphragm Function ◽  
Phrenic Nerves ◽  
And Gender ◽  
The Right ◽  
Conductive Properties

Abstract Background Diaphragm ultrasound allows for assessment of both diaphragm excursion and thickness. Cervical and cortical magnetic stimulation (CEMS and COMS) with recording of the diaphragmatic compound motor action potential (CMAP) is diagnostically useful to evaluate the conductive properties of the inspiratory pathway. Systolic heart failure (HF) is characterized by a loss of systolic pump function. Diaphragm weakness in HF has been reported to potentially contribute to exercise intolerance Methods 14 patients with systolic HF (11 men, 3 women; 64±12 years, NYHA 2±0.9, LVEF 36.1±5.6%) and 12 healthy controls matched for age and gender (4 men, 8 women; 56±8 years) underwent spirometric lung function testing and assessment of diaphragm excursion (during tidal breathing, TB, voluntary sniff, VS and deep breathing, DB) and thickness of the right hemidiaphragm by ultrasound. COMS and CEMS of the phrenic nerves with simultaneous bilateral recording of the diaphragm CMAP using surface electrodes was performed in 9 patients. Results Compared to controls, HF patients showed reduced forced vital capacity (75.46±18.05% vs. 107.62±17.13%, p<0.05). Diaphragm excursion amplitude was significantly reduced in HF patients (4.29±1.35 cm vs. 7.34±2.10 cm, p<0.05). Diaphragm contractility was impaired too, as reflected by the diaphragm thickening ratio (DTR; 2.01±0.46 vs. 2.53±0.74, p<0.05). Diaphragm CMAP following COMS and CEMS of the phrenic nerves revealed normal latencies in HF patients compared to controls (COMS Latency; 19.05±2.37 msec vs. 18.97±3.59 msec, p= n. s.). Conclusions Diaphragm involvement in systolic HF is reflected by reduced FVC and impaired ultrasound parameters of diaphragm function. Diaphragmatic pathology is likely to be myopathic because magnetic phrenic nerve conduction studies show no abnormalities. Diaphragm ultrasound may be useful as a diagnostic tool for assessment of diaphragm function in systolic HF. Acknowledgement/Funding This study was supported by Sanofi-Genzyme, Neu-Isenburg, Germany. The funders had no role in study design, data collection and analysis, preparation.

Pericardial mechanoreceptors with phrenic afferents

1993 ◽  
Vol 264 (6) ◽  
pp. H1836-H1846 ◽  
Author(s):  
D. R. Kostreva ◽  
S. P. Pontus
Keyword(s):  
Phrenic Nerve ◽  
Cardiac Rhythm ◽  
Afferent Activity ◽  
Fibrous Layer ◽  
Anesthetized Dogs ◽  
Anatomic Distribution ◽  
Phrenic Nerves ◽  
The Right

Pericardial mechanoreceptors with afferents in the phrenic nerves were studied in anesthetized dogs. The specific aims determined 1) if pericardial receptors with phrenic afferents exist in the dog; 2) the stimuli needed to activate these receptors; 3) the anatomic distribution of these pericardial receptors; and 4) which pericardial layer contains the receptors. Afferent activity was recorded from the phrenic nerves while the pericardium was probed. In 15 of 18 animals, pericardial receptors were found on the right side. In 12 of 18 animals pericardial receptors were located on the left side. Most of the mechanoreceptors were found in a band that paralleled the pericardiophrenic attachment, in the fibrous layer of the pericardium, overlying the atria and atrioventricular grooves. Some receptors had a cardiac rhythm, whereas others were stimulated by the inflating lung. None of the receptors were chemosensitive to capsaicin, bradykinin, or saline. This study is the first to demonstrate that the pericardium of the dog contains mechanosensitive receptors which are innervated by the phrenic nerve.

Sex and gender differences overview

ESC CardioMed ◽  
2018 ◽  
pp. 2827-2830
Author(s):  
Eva Prescott
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Obstructive Coronary Artery Disease ◽  
Systolic Heart Failure ◽  
Sex And Gender ◽  
Men And Women ◽  
Artery Disease ◽  
And Gender ◽  
Sex And Gender Differences

There are well-described differences between men and women in epidemiology, pathophysiology, presentation, and outcome of heart disease. Although risk factors responsible for cardiovascular disease are similar in men and women their relative importance differs. Puzzlingly, women have more angina yet less obstructive coronary artery disease. Also, when they suffer myocardial infarction, women more often present with myocardial infarction with non-obstructed coronary arteries (MINOCA) and takotsubo cardiomyopathy. Women have less systolic heart failure than men but more heart failure with preserved ejection fraction, a condition yet to find evidence-based treatment. Atrial fibrillation is also less common in women than men of similar age, but women with atrial fibrillation have higher risk of stroke than their male counterparts.

Role of Diastole in Left Ventricular Function, II: Diagnosis and Treatment

2004 ◽  
Vol 13 (6) ◽  
pp. 453-466 ◽  
Author(s):  
Shannan K. Hamlin ◽  
Penelope S. Villars ◽  
Joseph T. Kanusky ◽  
Andrew D. Shaw
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Left Atrial ◽  
Diastolic Heart Failure ◽  
Systolic Heart Failure ◽  
Clinical Signs ◽  
Left Ventricular ◽  
Exercise Intolerance ◽  
Radiographic Findings ◽  
Ventricular Compliance

Left ventricular diastolic dysfunction plays an important role in congestive heart failure. Although once thought to be lower, the mortality of diastolic heart failure may be as high as that of systolic heart failure. Diastolic heart failure is a clinical syndrome characterized by signs and symptoms of heart failure with preserved ejection fraction (0.50) and abnormal diastolic function. One of the earliest indications of diastolic heart failure is exercise intolerance followed by fatigue and, possibly, chest pain. Other clinical signs may include distended neck veins, atrial arrhythmias, and the presence of third and fourth heart sounds. Diastolic dysfunction is difficult to differentiate from systolic dysfunction on the basis of history, physical examination, and electrocardiographic and chest radiographic findings. Therefore, objective diagnostic testing with cardiac catheterization, Doppler echocardiography, and possibly measurement of serum levels of B-type natriuretic peptide is often required. Three stages of diastolic dysfunction are recognized. Stage I is characterized by reduced left ventricular filling in early diastole with normal left ventricular and left atrial pressures and normal compliance. Stage II or pseudonormalization is characterized by a normal Doppler echocardiographic transmitral flow pattern because of an opposing increase in left atrial pressures. This normalization pattern is a concern because marked diastolic dysfunction can easily be missed. Stage III, the final, most severe stage, is characterized by severe restrictive diastolic filling with a marked decrease in left ventricular compliance. Pharmacological therapy is tailored to the cause and type of diastolic dysfunction.

scholarly journals Exercise intolerance in comorbid COPD and heart failure: the role of impaired aerobic function

2019 ◽  
Vol 53 (4) ◽  
pp. 1802386 ◽  
Author(s):  
Alcides Rocha ◽  
Flavio F. Arbex ◽  
Priscila A. Sperandio ◽  
Frederico Mancuso ◽  
Mathieu Marillier ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Output ◽  
Systolic Heart Failure ◽  
Treatment Strategies ◽  
Symptom Burden ◽  
Cardiopulmonary Exercise Test ◽  
Forced Expiratory Volume ◽  
Exercise Intolerance ◽  
Chronic Obstructive ◽  
Aerobic Function

Impaired aerobic function is a potential mechanism of exercise intolerance in patients with combined cardiorespiratory disease. We investigated the pathophysiological and sensory consequences of a low change in oxygen uptake (ΔV′O2)/change in work rate (ΔWR) relationship during incremental exercise in patients with coexisting chronic obstructive pulmonary disease (COPD) and systolic heart failure (HF).After clinical stabilisation, 51 COPD–HF patients performed an incremental cardiopulmonary exercise test to symptom limitation. Cardiac output was non-invasively measured (impedance cardiography) in a subset of patients (n=18).27 patients presented with ΔV′O2/ΔWR below the lower limit of normal. Despite similar forced expiratory volume in 1 s and ejection fraction, the low ΔV′O2/ΔWR group showed higher end-diastolic volume, lower inspiratory capacity and lower transfer factor compared to their counterparts (p<0.05). Peak WR and peakV′O2were ∼15% and ∼30% lower, respectively, in the former group: those findings were associated with greater symptom burden in daily life and at a given exercise intensity (leg discomfort and dyspnoea). The low ΔV′O2/ΔWR group presented with other evidences of impaired aerobic function (sluggishV′O2kinetics, earlier anaerobic threshold) and cardiocirculatory performance (lower oxygen pulse, lower stroke volume and cardiac output) (p<0.05). Despite similar exertional hypoxaemia, they showed worse ventilatory inefficiency and higher operating lung volumes, which led to greater mechanical inspiratory constraints (p<0.05).Impaired aerobic function due to negative cardiopulmonary–muscular interactions is an important determinant of exercise intolerance in patients with COPD–HF. Treatment strategies to improve oxygen delivery to and/or utilisation by the peripheral muscles might prove particularly beneficial to these patients.

DISEASE MANAGEMENT REDUCES RACIAL AND GENDER DIFFERENCES IN SURVIVAL AMONG INDIGENT PATIENTS WITH SYSTOLIC HEART FAILURE

CHEST Journal ◽  
2007 ◽  
Vol 132 (4) ◽  
pp. 580C
Author(s):  
Lee M. Arcement ◽  
Ron Horswell ◽  
Manpreet Singh ◽  
Joey Key ◽  
Michael Butler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Disease Management ◽  
Systolic Heart Failure ◽  
And Gender

Plasma urocortin in human systolic heart failure

2004 ◽  
Vol 106 (4) ◽  
pp. 383-388 ◽  
Author(s):  
Leong L. NG ◽  
Ian W. LOKE ◽  
Russell J. O'BRIEN ◽  
Iain B. SQUIRE ◽  
Joan E. DAVIES
Keyword(s):  
Heart Failure ◽  
New York ◽  
Nyha Class ◽  
Systolic Heart Failure ◽  
Area Under The Curve ◽  
Logistic Models ◽  
Heart Association ◽  
Roc Curves ◽  
Relative Increase ◽  
And Gender

Urocortin (UCN), a member of the corticotrophin-releasing factor family, is expressed in heart, brain and gut. UCN has potent cardiostimulatory, cardioprotective, vasodilator and diuretic/natriuretic effects, and cardiac UCN expression is increased in heart failure (HF). In the present study, we investigated plasma levels of UCN in 119 patients with HF and 212 age- and gender-matched controls to clarify its relationship with gender and disease severity. UCN was elevated in HF [normal males, 19.5 (3.9–68.8) pmol/l and HF males, 50.2 (6.9–108.2) pmol/l, P<0.0005; normal females, 14.2 (3.9–53.5) pmol/l and HF females, 21.8 (3.9–112.5) pmol/l, P<0.001; values are medians (range)]. The relative increase was greater in males than females (P<0.03). UCN fell with increasing age, especially in HF patients (rs=-0.56, P<0.0005) and with increasing New York Heart Association (NYHA) class (rs=-0.55, P<0.0005). The fall in UCN levels with increasing NYHA class was reinforced by a significant correlation between UCN and ejection fraction (rs=0.45, P<0.0005) in HF patients. Although receiver operating characteristic (ROC) curves for diagnosis of all HF cases yielded an area under the curve (AUC) of 0.76, ROC AUCs for patients with early HF (NYHA class I and II) were better (0.91). ROC AUCs for logistic models incorporating N-terminal probrain natriuretic peptide (N-BNP) and UCN were better than either peptide alone. In conclusion, plasma UCN is elevated in HF, especially in its early stages. Its decline with increasing HF severity may expedite disease progression due to diminished cardioprotective/anti-inflammatory effects. UCN measurement may also complement N-BNP in the diagnosis of early HF.

Usefulness of C-Reactive Protein Plasma Levels to Predict Exercise Intolerance in Patients With Chronic Systolic Heart Failure

2016 ◽  
Vol 117 (1) ◽  
pp. 116-120 ◽  
Author(s):  
Justin McNair Canada ◽  
Daniel Taylor Fronk ◽  
Laura Freeman Cei ◽  
Salvatore Carbone ◽  
Claudia Oddi Erdle ◽  
...  
Keyword(s):  
Heart Failure ◽  
Plasma Levels ◽  
Systolic Heart Failure ◽  
Exercise Intolerance ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Chronic Systolic Heart Failure

Phrenic nerve conduction times and twitch pressures of the human diaphragm

1985 ◽  
Vol 58 (5) ◽  
pp. 1496-1504 ◽  
Author(s):  
D. K. McKenzie ◽  
S. C. Gandevia
Keyword(s):  
Phrenic Nerve ◽  
Simultaneous Recording ◽  
Emg Activity ◽  
Conduction Time ◽  
Transdiaphragmatic Pressure ◽  
Surface Electrodes ◽  
Midclavicular Line ◽  
Phrenic Nerves ◽  
The Mean ◽  
The Right

A multilumen catheter was modified to allow simultaneous recording of transdiaphragmatic pressure (Pdi) and the electromyographic (EMG) activity of the diaphragm. The catheter was used in 20 healthy males to measure the conduction time of the phrenic nerves and the twitch pressure of each hemidiaphragm during single supramaximal shocks delivered to the phrenic nerve in the neck. Diaphragmatic EMG was also recorded with surface electrodes at various sites on the chest wall. The mean conduction time to the crural fibers was 6.82 +/- 0.64 ms on the right and 7.93 +/- 0.85 ms on the left, whereas that to the costal fibers adjacent to the midclavicular line was 7.68 +/- 0.56 ms on the right and 7.92 +/- 0.92 ms on the left. Significant correlations were found between the conduction time of each phrenic nerve and the height and the age of the subjects. Conduction times measured at different EMG recording sites varied by as much as 2 ms. This variability, and that of previously reported values for phrenic conduction time, may be largely accounted for by differences in the conduction distances that were measured to each site in three cadavers. The evoked change in Pdi had a mean rise time of 92 ms and an amplitude of approximately 10 cmH2O.

scholarly journals Effects of exercise training on neurovascular control and skeletal myopathy in systolic heart failure

2015 ◽  
Vol 308 (8) ◽  
pp. H792-H802 ◽  
Author(s):  
Carlos E. Negrao ◽  
Holly R. Middlekauff ◽  
Igor L. Gomes-Santos ◽  
Ligia M. Antunes-Correa
Keyword(s):  
Heart Failure ◽  
Exercise Training ◽  
Systolic Dysfunction ◽  
Systolic Heart Failure ◽  
Exercise Intolerance ◽  
Peripheral Blood Flow ◽  
Peripheral Vasoconstriction ◽  
Beneficial Effects ◽  
Ventilatory Responses ◽  
Skeletal Myopathy

Neurohormonal excitation and dyspnea are the hallmarks of heart failure (HF) and have long been associated with poor prognosis in HF patients. Sympathetic nerve activity (SNA) and ventilatory equivalent of carbon dioxide (VE/VO2) are elevated in moderate HF patients and increased even further in severe HF patients. The increase in SNA in HF patients is present regardless of age, sex, and etiology of systolic dysfunction. Neurohormonal activation is the major mediator of the peripheral vasoconstriction characteristic of HF patients. In addition, reduction in peripheral blood flow increases muscle inflammation, oxidative stress, and protein degradation, which is the essence of the skeletal myopathy and exercise intolerance in HF. Here we discuss the beneficial effects of exercise training on resting SNA in patients with systolic HF and its central and peripheral mechanisms of control. Furthermore, we discuss the exercise-mediated improvement in peripheral vasoconstriction in patients with HF. We will also focus on the effects of exercise training on ventilatory responses. Finally, we review the effects of exercise training on features of the skeletal myopathy in HF. In summary, exercise training plays an important role in HF, working synergistically with pharmacological therapies to ameliorate these abnormalities in clinical practice.

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