Structural, morphological and functional changes of diaphragm in patients with chronic heart failure

Shabaev VS, Makarov IA, Mitrofanova LB, et al. . Structural, morphological and functional changes of diaphragm in patients with chronic heart failure. Russian Journal of Anesthesiology and Reanimatology. 2024;(5):88‑95. (In Russ.)
https://doi.org/10.17116/anaesthesiology202405188

Использование инфографики авторами научных работ

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BACKGROUND

Mechanical respiratory support is recommended for acute decompensation of chronic heart failure (CHF). Patients with CHF can develop morphological and functional changes of diaphragm not associated with respiratory support. Extrapolation of diaphragm-protective mechanical ventilation principles seems reasonable in these patients.

OBJECTIVE

To assess morphological and functional changes of diaphragm in patients with decompensated CHF.

MATERIAL AND METHODS

A two-stage study included 28 patients: stage 1 — clinical (10 patients), stage 2 (morphological) — 18 deceased patients. Stage 1 implied comparison of two groups: group 1 (improvement) — patients discharged from ICU (n=7), group 2 (deterioration) — extracorporeal membrane oxygenation (ECMO) as a bridge to heart transplantation (n=3). We performed ultrasound assessment of structural (thickness) and functional (thickening fraction and excursion) state of diaphragm under calm and deep inhalation/exhalation. External respiration was assessed using spirometry function of ventilator. Stage 2 is presented by comparative morphological assessment of muscular part of diaphragm in 11 patients who died from CHF and 7 patients who died from other reasons.

RESULTS

Diaphragm thickness (cm) decreased at discharge from ICU in group 1: on the right — calm inhalation 0.31 (0.3; 0.39)/0.22 (0.2; 0.27) (p=0.027), calm exhalation 0.26 (0.2; 0.36)/0.19 (0.1; 0.2) (p=0.04) (admission date/ discharge date). In group 2, diaphragm thickening (cm) was observed by the date of ECMO onset: on the right — calm inhalation 0.27±0.05/0.43±0.18, calm exhalation 0.21±0.03/0.25±0.03. There was deterioration of spirometry indicators: NIF (Mbar) — 30.0±15.2/13.3±3.0, deep inhalation volume (ml) 1696.6±603.6/1283.3±256.5 (admission/ECMO onset). In deceased patients, histological analysis revealed diaphragm thickening (2.5 (2.0; 3.1)/1.6 (1.4; 1.8) mm, p=0.006) due to edema (2.0 (1.5; 2.5)/0.9 (0.2; 1.5 points, p=0.011) and hypertrophy of muscle fibers (transverse diameter of muscle fiber 42.0 (37.6; 46.4)/34.9 (32.5; 35.9) µm, p=0.015) compared to patients died from other reasons.

CONCLUSION

Intermuscular edema and hypertrophy of muscle fibers cause thickening and dysfunction of diaphragm in patients with CHF. This justifies extrapolation of diaphragm-protective respiratory support strategy to these patients. Ultrasound dynamic assessment of diaphragm state is useful in patients with decompensated CHF for analysis of therapeutic efficiency and prediction of outcomes.

Keywords:

diaphragm dysfunction

chronic heart failure

ultrasound of diaphragm

diaphragm

lung function

diaphragm function

morphology of diaphragm

diaphragm-protective mechanical ventilation

Authors:

Shabaev V.S.

Almazov National Medical Research Centre

ORCID: 0000-0002-5336-003X

Makarov I.A.

Almazov National Medical Research Centre

ORCID: 0000-0001-6175-8403

Mitrofanova L.B.

Almazov National Medical Research Centre

SPIN RSCI: 9552-8248
ORCID: 0000-0003-0735-7822

Vasilyeva L.G.

Almazov National Medical Research Center

ORCID: 0000-0001-9611-9222

Biktasheva L.Z.

Almazov National Medical Research Centre

ORCID: 0000-0002-6650-6528

Mazurok V.A.

Almazov North-Western Federal Medical Research Center

SPIN RSCI: 6091-1102
Scopus AuthorID: 24475404300
ORCID: 0000-0003-3917-0771

Danilova I.A.

Almazov National Medical Research Centre

ORCID: 0000-0003-0865-5936

Osipova N.A.

Almazov National Medical Research Centre

ORCID: 0000-0002-7352-0010

Received:

19.02.2024

Accepted:

09.04.2024

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