Features of inspiratory muscle functional state in patients with heart failure with preserved ejection fraction

Abstract

BACKGROUND: Chronic heart failure contributes to multiorgan dysfunction, including skeletal muscle impairment.

AIM: This study aimed to assess the strength and electrical activity of inspiratory muscles in patients with chronic heart failure with preserved left ventricular ejection fraction.

MATERIAL AND METHODS: Eighty patients of both sexes aged 45–74 years were included and divided into three groups: group 1 comprised 24 patients with chronic heart failure classified as NYHA functional class II, group 2 included 20 patients with NYHA class I chronic heart failure, and group 3 (control group) involved 36 patients without chronic heart failure. All participants underwent evaluation for serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, a 6-minute walk test, assessment of inspiratory muscle strength, and surface electromyography of inspiratory muscles during three loading tests. The significance of intergroup differences was assessed using the Mann–Whitney and Pearson χ² tests.

RESULTS: When stratified by sex, women in group 1 had 31.5% lower maximal inspiratory pressure than those in the control group (p = 0.006). The patients in group 1 demonstrated a smaller increase in diaphragm electromyography amplitude during the first test—sustained inspiratory effort at 30% intensity for 15 seconds—by 27.9% (p = 0.010), 26.1% (p = 0.025), and 40.7% (p = 0.033) at 5, 10, and 15 seconds, respectively. In the second test—sustained inspiratory effort at 50% intensity for 5 seconds—electromyography amplitude decreased by 32.6% (p = 0.041) at 5 seconds. In the third test—sustained inspiratory effort at 70% intensity for 5 seconds—the reduction was 42.8% (p = 0.009) at 5 seconds compared with the control group. Additionally, a more pronounced decrease in electromyography frequency was observed during the first test—by 24.2% (p = 0.048) and 24.7% (p = 0.030) compared with the control group—indicating fatigue. In the accessory inspiratory muscles, electromyography amplitude gain was higher in group 1 than in the control group, showing activation of additional motor units: in the external intercostal muscles during the first test, by 31.7% (p = 0.032) and 37.9% (p = 0.044) and by 28.9% (p = 0.048) and 43.1% (p = 0.036) during the second test; and in the sternocleidomastoid muscle during the first test by 66.1% (p = 0.033) and 49.4% (p = 0.043) and by 128.6% (p = 0.032) during the second test.

CONCLUSION: Surface electromyography with loading tests revealed diaphragm fatigue and increased activation of accessory inspiratory muscles in patients with NYHA class II chronic heart failure.

Keywords

chronic heart failure / surface electromyography / maximal inspiratory pressure / inspiratory muscles

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