Universität zu Köln

Spiesshoefer, Jens ORCID: 0000-0001-8205-1749, Herkenrath, Simon, Mohr, Michael, Randerath, Winfired, Tuleta, Izabela, Diller, Gerhard Paul, Emdin, Michele, Young, Peter, Henke, Carolin, Florian, Anca Rezeda, Yilmaz, Ali, Boentert, Matthias and Giannoni, Alberto ORCID: 0000-0001-9314-2005 (2019). Diaphragm function does not independently predict exercise intolerance in patients with precapillary pulmonary hypertension after adjustment for right ventricular function. Biosci. Rep., 39. LONDON: PORTLAND PRESS LTD. ISSN 1573-4935

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Abstract

Background: Several determinants of exercise intolerance in patients with precapillary pulmonary hypertension (PH) due to pulmonary arterial hypertension and /or chronic thromboembolic PH (CTEPH) have been suggested, including diaphragm dysfunction. However, these have rarely been evaluated in a multimodal manner. Methods: Forty-three patients with PH (age 58 +/- 17 years, 30% male) and 43 age- and gender-matched controls (age 54 +/- 13 years, 30% male) underwent diaphragm function (excursion and thickening) assessment by ultrasound, standard spirometry, arterial blood gas analysis, echocardiographic assessment of pulmonary artery pressure (PAP), assay of amino-terminal pro-brain natriuretic peptide (NT-proBNP) levels, and cardiac magnetic resonance (CMR) imaging to evaluate right ventricular systolic ejection fraction (RVEF). Exercise capacity was determined using the 6-min walk distance (6MWD). Results: Excursion velocity during a sniff maneuver (SniffV, 4.5 +/- 1.7 vs. 6.8 +/- 2.3 cm /s, P< 0.01) and diaphragm thickening ratio (DTR, 1.7 +/- 0.5 vs. 2.8 +/- 0.8, P< 0.01) were significantly lower in PH patients versus controls. PH patients with worse exercise tolerance (6MWD < 377 vs. >= 377 m) were characterized by worse SniffV, worse DTR, and higher NT-pro-BNP levels as well as by lower arterial carbon dioxide levels and RVEF, which were all univariate predictors of exercise limitation. On multivariate analysis, the only independent predictors of exercise limitation were RVEF (r = 0.47, P= 0.001) and NT-proBNP (r = -0.27, P= 0.047). Conclusion: Patients with PH showed diaphragm dysfunction, especially as exercise intolerance progressed. However, diaphragm dysfunction does not independently contribute to exercise intolerance, beyond what can be explained from right heart failure.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Spiesshoefer, Jens UNSPECIFIED orcid.org/0000-0001-8205-1749 UNSPECIFIED Herkenrath, Simon UNSPECIFIED UNSPECIFIED UNSPECIFIED Mohr, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Randerath, Winfired UNSPECIFIED UNSPECIFIED UNSPECIFIED Tuleta, Izabela UNSPECIFIED UNSPECIFIED UNSPECIFIED Diller, Gerhard Paul UNSPECIFIED UNSPECIFIED UNSPECIFIED Emdin, Michele UNSPECIFIED UNSPECIFIED UNSPECIFIED Young, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Henke, Carolin UNSPECIFIED UNSPECIFIED UNSPECIFIED Florian, Anca Rezeda UNSPECIFIED UNSPECIFIED UNSPECIFIED Yilmaz, Ali UNSPECIFIED UNSPECIFIED UNSPECIFIED Boentert, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED Giannoni, Alberto UNSPECIFIED orcid.org/0000-0001-9314-2005 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-141793
DOI:	10.1042/BSR20190392
Journal or Publication Title:	Biosci. Rep.
Volume:	39
Date:	2019
Publisher:	PORTLAND PRESS LTD
Place of Publication:	LONDON
ISSN:	1573-4935
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESPIRATORY MUSCLE FUNCTION; ARTERIAL-HYPERTENSION; PROGNOSTIC VALUE; HEART-FAILURE; DYSFUNCTION; STRENGTH; VOLUME Multiple languages Biochemistry & Molecular Biology; Cell Biology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14179