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(Circulation. 2001;103:2153.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Respiratory Muscle Dysfunction in Congestive Heart Failure
Clinical Correlation and Prognostic Significance
From the Department of Cardiology, Angiology, and Respiratory Medicine, Medical Center of the University Heidelberg, Heidelberg, Germany.
Correspondence to Dr med F. Joachim Meyer, Abteilung Innere Medizin III, Bergheimer Strasse 58, D-69115 Heidelberg, Germany. E-mail Joachim_Meyer{at}med.uni-heidelberg.de
Background—In congestive heart failure (CHF), the prognostic significance of impaired respiratory muscle strength has not been established.
Methods and
Results—Maximal inspiratory pressure
(Pimax) was prospectively determined in 244
consecutive patients (207 men) with CHF (ischemic, n=75;
idiopathic dilated cardiomyopathy, n=169; age,
54±11 years; left ventricular ejection fraction [LVEF],
22±10%). Pimax was lower in the 244 patients
with CHF than in 25 control subjects (7.6±3.3 versus 10.5±3.7 kPa;
P=0.001). The 57 patients
(23%) who died during follow-up (23±16 months; range, 1 to 48 months)
had an even more reduced Pimax (6.3±3.2 versus
8.1±3.2 kPa in survivors;
P=0.001). Kaplan-Meier survival
curves differentiated between patients subdivided according to
quartiles for Pimax
(P=0.014).
Pimax was a strong risk predictor in both
univariate
(P=0.001) and
multivariate Cox proportional hazard analyses
(P=0.03);
multivariate analyses also included NYHA
functional class, LVEF, peak oxygen consumption (peak
O2),
and norepinephrine plasma concentration. The areas under
the receiver-operating characteristic curves for prediction of 1-year
survival were comparable for Pimax and peak
O2
(area under the curve [AUC], 0.68 versus 0.73;
P=0.28), and they improved with
the triple combination of Pimax, peak
O2,
and LVEF (AUC, 0.82; P=0.004
compared with AUC of
Pimax).
Conclusions—In patients with CHF, inspiratory muscle strength is reduced and emerges as a novel, independent predictor of prognosis. Because testing for Pimax is simple in clinical practice, it might serve as an additional factor to improve risk stratification and patient selection for cardiac transplantation.
Key Words: heart failure • muscles • exercise • prognosis
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