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European Journal of Heart Failure 2006 8(1):68-73; doi:10.1016/j.ejheart.2005.04.009
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© 2005 European Society of Cardiology

Does symptom-limited cycle exercise cause low frequency diaphragm fatigue in patients with heart failure?

Mark J. Dayera,*, Nicholas S. Hopkinsona, Ewen T. Rossb, Sophie Jonvillea, Tarek Sharshara, Mark Kearneyc, John Moxhamd and Michael I. Polkeya

a Respiratory Muscle Laboratory, Royal Brompton and Harefield N.H.S Trust Royal Brompton Hospital, London, UK
b Department of Respiratory Medicine Gartnavel General Hospital, Glasgow, UK
c Department of Cardiology, Guy's, King's and St. Thomas' School of Medicine Kings College Hospital, London, UK
d Department of Respiratory Medicine, Guy's, King's and St. Thomas' School of Medicine Kings College Hospital, London, UK

* Corresponding author. Tel.: +44 020 7351 8029; fax: +44 020 7351 8939. E-mail address: markdayer{at}gmail.com


  Abstract

Background: Reduced diaphragm contractility occurs in some healthy subjects when they exercise to exhaustion. This indicates low frequency fatigue, which may contribute to task failure. We hypothesised that patients with congestive heart failure (CHF) might be especially vulnerable to the development of low frequency diaphragm fatigue after exhaustive exercise.

Aims: To study the effect of exhaustive incremental cycle exercise on diaphragm contractility in patients with CHF.

Methods: 12 patients with CHF with an ejection fraction of 36.5±7.3% and 12 healthy age-matched control subjects performed an incremental cycle test to exhaustion. The unpotentiated twitch transdiaphragmatic pressure (twitch Pdi) in response to bilateral anterolateral magnetic phrenic nerve stimulation (BAMPS) was measured before and after exercise.

Results: Twitch Pdi at baseline was 20.2±6.7 cmH2O in the CHF group and 20.3±3 cmH2O in the controls (p=0.957). 25 and 35 min post exercise the values were 19.9±5.4 and 20.0±5.1 cmH2O in the CHF group and 20.6±4.3 and 21.2±3.4 cmH2O in the control group; neither change was significant (F(2,27)=0.007, p=0.993; F(2,33)=0.144, p=0.866, respectively).

Conclusion: When patients with CHF cycle to exhaustion, low frequency fatigue of the diaphragm does not occur, and this is unlikely to be an important factor limiting exercise capacity of such patients.

Key Words: Heart failure • Congestive • Respiratory muscles • Muscle fatigue

Received December 8, 2004; Accepted April 18, 2005


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