Skip to content
2000
Volume 21, Issue 3
  • ISSN: 1573-403X
  • E-ISSN: 1875-6557

Abstract

Introduction

Dyspnea and exertional intolerance are the most common clinical manifestations of Heart Failure (HF). One of the possible mechanisms of both symptoms in HF patients is weakness of the inspiratory muscles.

Aim

Because the diaphragm is the main inspiratory muscle, this review aimed to investigate the contribution of diaphragmatic function to the genesis of dyspnea or exercise intolerance in HF patients.

Methods

Original articles, clinical trials, and cohort or case-control studies published between January 2003 and March 2023 were included. The population, variables, and outcome strategy were the basis of this review, including studies that assessed HF patients, diaphragmatic function, and dyspnea or exercise tolerance. The PubMed/MEDLINE, Embase, and BVS/LILACS databases were searched.

Results and Discussion

A total of 353 articles were identified from electronic databases. After removing duplicate articles and screening based on titles, abstracts, and full texts, nine articles were included in the qualitative synthesis of this review. These studies were quite heterogeneous in their methodologies; however, most, except two, demonstrated an association among diaphragmatic dysfunction, dyspnea, and exertional intolerance in HF patients.

Conclusion

Although few studies have assessed the contribution of diaphragmatic function to dyspnea and exertional intolerance in HF individuals, the vast majority of articles included in this review found such an association, especially when diaphragmatic function was assessed using ultrasound.

© 2025 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/ccr/10.2174/011573403X330739241216185852
2025-01-21
2025-08-18

  • From This Site

    /content/journals/ccr/10.2174/011573403X330739241216185852
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. SavareseG. BecherP.M. LundL.H. SeferovicP. RosanoG.M.C. CoatsA.J.S. Global burden of heart failure: A comprehensive and updated review of epidemiology.Cardiovasc. Res.2023118173272328710.1093/cvr/cvac013 35150240
     [Google Scholar]
  2. RogerV.L. WestonS.A. RedfieldM.M. Trends in heart failure incidence and survival in a community-based population.JAMA2004292334435010.1001/jama.292.3.344 15265849
     [Google Scholar]
  3. StewartS. MacIntyreK. HoleD.J. CapewellS. McMurrayJ.J.V. More ‘malignant’ than cancer? Five‐year survival following a first admission for heart failure.Eur. J. Heart Fail.20013331532210.1016/S1388‑9842(00)00141‑0 11378002
     [Google Scholar]
  4. HoekstraT. Lesman-LeegteI. van VeldhuisenD.J. SandermanR. JaarsmaT. Quality of life is impaired similarly in heart failure patients with preserved and reduced ejection fraction.Eur. J. Heart Fail.20111391013101810.1093/eurjhf/hfr072 21712287
     [Google Scholar]
  5. YancyC.W. JessupM. BozkurtB. 2013 ACCF/AHA guideline for the management of heart failure.J. Am. Coll. Cardiol.20136216e147e23910.1016/j.jacc.2013.05.019 23747642
     [Google Scholar]
  6. CoatsA. The “muscle hypothesis” of chronic heart failure.J. Mol. Cell. Cardiol.199628112255226210.1006/jmcc.1996.0218 8938579
     [Google Scholar]
  7. MeyerF.J. BorstM.M. ZugckC. Respiratory muscle dysfunction in congestive heart failure: Clinical correlation and prognostic significance.Circulation2001103172153215810.1161/01.CIR.103.17.2153 11331255
     [Google Scholar]
  8. ManciniD.M. HensonD. LaMancaJ. LevineS. Respiratory muscle function and dyspnea in patients with chronic congestive heart failure.Circulation199286390991810.1161/01.CIR.86.3.909 1516204
     [Google Scholar]
  9. McparlandC. KrishnanB. WangY. GallagherC.G. Inspiratory muscle weakness and dyspnea in chronic heart failure.Am. Rev. Respir. Dis.1992146246747210.1164/ajrccm/146.2.467 1489142
     [Google Scholar]
  10. RibeiroJ.P. ChiappaG.R. NederJ.A. FrankensteinL. Respiratory muscle function and exercise intolerance in heart failure.Curr. Heart Fail. Rep.2009629510110.1007/s11897‑009‑0015‑7 19486593
     [Google Scholar]
  11. EpsteinS.K. An overview of respiratory muscle function.Clin. Chest Med.199415461963910.1016/S0272‑5231(21)00957‑6 7867279
     [Google Scholar]
  12. DubéB.P. DresM. Diaphragm dysfunction: Diagnostic approaches and management strategies.J. Clin. Med.201651211310.3390/jcm5120113 27929389
     [Google Scholar]
  13. BeelerR. SchoenenbergerA.W. BauerP. Improvement of cardiac function with device‐based diaphragmatic stimulation in chronic heart failure patients: The randomized, open‐label, crossover epiphrenic II pilot trial.Eur. J. Heart Fail.201416334234910.1002/ejhf.20 24464736
     [Google Scholar]
  14. YamadaK. KinugasaY. SotaT. Inspiratory muscle weakness is associated with exercise intolerance in patients with heart failure with preserved ejection fraction: A preliminary study.J. Card. Fail.2016221384710.1016/j.cardfail.2015.10.010 26505812
     [Google Scholar]
  15. MiyagiM. KinugasaY. SotaT. Diaphragm muscle dysfunction in patients with heart failure.J. Card. Fail.201824420921610.1016/j.cardfail.2017.12.004 29289723
     [Google Scholar]
  16. KinugasaY. MiyagiM. SotaT. Dynapenia and diaphragm muscle dysfunction in patients with heart failure.Eur. J. Prev. Cardiol.201825161785178610.1177/2047487318793212 30080099
     [Google Scholar]
  17. LuisoD. VillanuevaJ.A. Belarte-TorneroL.C. Surface respiratory electromyography and dyspnea in acute heart failure patients.PLoS One2020154e023222510.1371/journal.pone.0232225 32348374
     [Google Scholar]
  18. AndriopoulouM. DimakiN. KallistratosM.S. Skeletal muscle alterations and exercise intolerance in heart failure with preserved ejection fraction patients: Ultrasonography assessment of diaphragm and quadriceps.Eur. J. Heart Fail.202224472973110.1002/ejhf.2462 35229401
     [Google Scholar]
  19. NavaS. Teresa LarovereM. FanfullaF. NavalesiP. DelmastroM. MortaraA. Orthopnea and inspiratory effort in chronic heart failure patients.Respir. Med.200397664765310.1053/rmed.2003.1495 12814149
     [Google Scholar]
  20. DayerM.J. HopkinsonN.S. RossE.T. Does symptom‐limited cycle exercise cause low frequency diaphragm fatigue in patients with heart failure?Eur. J. Heart Fail.200681687310.1016/j.ejheart.2005.04.009 16081318
     [Google Scholar]
  21. SpiesshoeferJ. HenkeC. KabitzH.J. Heart failure results in inspiratory muscle dysfunction irrespective of left ventricular ejection fraction.Respiration202110029610810.1159/000509940 33171473
     [Google Scholar]
  22. ChenL.K. WooJ. AssantachaiP. Asian working group for sarcopenia: 2019 consensus update on sarcopenia diagnosis and treatment.J. Am. Med. Dir. Assoc.2020213300307.e210.1016/j.jamda.2019.12.012 32033882
     [Google Scholar]
  23. BorgG. Perceived exertion as an indicator of somatic stress.J. Rehabil. Med.197022929810.2340/1650197719702239298 5523831
     [Google Scholar]
  24. ChuaT.P. AnkerS.D. HarringtonD. CoatsA.J. Inspiratory muscle strength is a determinant of maximum oxygen consumption in chronic heart failure.Heart199574438138510.1136/hrt.74.4.381 7488451
     [Google Scholar]
  25. MeyerF.J. ZugckC. HaassM. Inefficient ventilation and reduced respiratory muscle capacity in congestive heart failure.Basic Res. Cardiol.200095433334210.1007/s003950070053 11005589
     [Google Scholar]
  26. AmbrosinoN. OpasichC. CrottiP. CobelliF. TavazziL. RampullaC. Breathing pattern, ventilatory drive and respiratory muscle strength in patients with chronic heart failure.Eur. Respir. J.199471172210.1183/09031936.94.07010017 8143818
     [Google Scholar]
  27. FiluschA. EwertR. AltesellmeierM. Respiratory muscle dysfunction in congestive heart failure-The role of pulmonary hypertension.Int. J. Cardiol.2011150218218510.1016/j.ijcard.2010.04.006 20444510
     [Google Scholar]
  28. LaoutarisI. DritsasA. BrownM.D. ManginasA. AlivizatosP.A. CokkinosD.V. Inspiratory muscle training using an incremental endurance test alleviates dyspnea and improves functional status in patients with chronic heart failure.Eur. J. Cardiovasc. Prev. Rehabil.200411648949610.1097/01.hjr.0000152242.51327.63 15580060
     [Google Scholar]
  29. LaoutarisI.D. DritsasA. BrownM.D. Immune response to inspiratory muscle training in patients with chronic heart failure.Eur. J. Cardiovasc. Prev. Rehabil.200714567968610.1097/HJR.0b013e3281338394 17925628
     [Google Scholar]
  30. LaoutarisI.D. DritsasA. BrownM.D. Effects of inspiratory muscle training on autonomic activity, endothelial vasodilator function, and N-terminal pro-brain natriuretic peptide levels in chronic heart failure.J. Cardiopulm. Rehabil. Prev.20082829910610.1097/01.HCR.0000314203.09676.b9 18360185
     [Google Scholar]
  31. Bosnak-GucluM. ArikanH. SavciS. Effects of inspiratory muscle training in patients with heart failure.Respir. Med.2011105111671168110.1016/j.rmed.2011.05.001 21621993
     [Google Scholar]
  32. MelloP.R. GuerraG.M. BorileS. Inspiratory muscle training reduces sympathetic nervous activity and improves inspiratory muscle weakness and quality of life in patients with chronic heart failure: A clinical trial.J. Cardiopulm. Rehabil. Prev.201232525526110.1097/HCR.0b013e31825828da 22785143
     [Google Scholar]
  33. Dall’AgoP. ChiappaG.R.S. GuthsH. SteinR. RibeiroJ.P. Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: A randomized trial.J. Am. Coll. Cardiol.200647475776310.1016/j.jacc.2005.09.052 16487841
     [Google Scholar]
  34. ChiappaG.R. RoseguiniB.T. VieiraP.J.C. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure.J. Am. Coll. Cardiol.200851171663167110.1016/j.jacc.2007.12.045 18436118
     [Google Scholar]
  35. SteinR. ChiappaG.R. GüthsH. Dall’AgoP. RibeiroJ.P. Inspiratory muscle training improves oxygen uptake efficiency slope in patients with chronic heart failure.J. Cardiopulm. Rehabil. Prev.200929639239510.1097/HCR.0b013e3181b4cc41 19809347
     [Google Scholar]
  36. MorenoA.M. Toledo-ArrudaA.C. LimaJ.S. DuarteC.S. VillacortaH. NóbregaA.C.L. Inspiratory muscle training improves intercostal and forearm muscle oxygenation in patients with chronic heart failure: Evidence of the origin of the respiratory metaboreflex.J. Card. Fail.201723967267910.1016/j.cardfail.2017.05.003 28499979
     [Google Scholar]
  37. LindsayD.C. LovegroveC.A. DunnM.J. Histological abnormalities of muscle from limb, thorax and diaphragm in chronic heart failure.Eur. Heart J.19961781239125010.1093/oxfordjournals.eurheartj.a015042 8869866
     [Google Scholar]
  38. StassijnsG. Gayan-RamirezG. De LeynP. Effects of dilated cardiomyopathy on the diaphragm in the Syrian hamster.Eur. Respir. J.199913239139710.1183/09031936.99.13239199 10065687
     [Google Scholar]
  39. GuazziM. DicksteinK. VicenziM. ArenaR. Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: A comparative analysis on clinical and prognostic insights.Circ. Heart Fail.20092654955510.1161/CIRCHEARTFAILURE.109.881326 19919979
     [Google Scholar]
/content/journals/ccr/10.2174/011573403X330739241216185852
Loading
Dyspnea and Heart Failure: The Role of the Diaphragm
Curr. Cardiol. Rev. 21, E1573403X330739 (2025); https://doi.org/10.2174/011573403X330739241216185852
/content/journals/ccr/10.2174/011573403X330739241216185852
/content/journals/ccr/10.2174/011573403X330739241216185852
Loading

Data & Media loading...

Supplements

Supplementary material is available on the publisher’s website along with the published article.

file format download Download

  • Article Type:     Review Article
Keyword(s): Diaphragm; dyspnea; electronic databases; exercise intolerance; heart failure; inspiratory muscles; ultrasound

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test