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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

F. Joachim Meyer, MD; Mathias M. Borst, MD; Christian Zugck, MD; Andreas Kirschke; Dieter Schellberg, PhD; Wolfgang Kübler, MD, FRCP; Markus Haass, MD

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 (Pi_max) 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%). Pi_max 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 Pi_max (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 Pi_max (P=0.014). Pi_max 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 Pi_max and peak O₂ (area under the curve [AUC], 0.68 versus 0.73; P=0.28), and they improved with the triple combination of Pi_max, peak O₂, and LVEF (AUC, 0.82; P=0.004 compared with AUC of Pi_max).

Conclusions—In patients with CHF, inspiratory muscle strength is reduced and emerges as a novel, independent predictor of prognosis. Because testing for Pi_max 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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