More Impaired Dynamic Ventilatory Muscle Oxygenation in Congestive Heart Failure than in Chronic Obstructive Pulmonary Disease

Abstract

Patients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) often have dyspnea. Despite differences in primary organ derangement and similarities in secondary skeletal muscle changes, both patient groups have prominent functional impairment. With similar daily exercise performance in patients with CHF and COPD, we hypothesized that patients with CHF would have worse ventilatory muscle oxygenation than patients with COPD. This study aimed to compare differences in tissue oxygenation and blood capacity between ventilatory muscles and leg muscles and between the two patient groups. Demographic data, lung function, and maximal cardiopulmonary exercise tests were performed in 134 subjects without acute illnesses. Muscle oxygenation and blood capacity were measured using frequency-domain near-infrared spectroscopy (fd-NIRS). We enrolled normal subjects and patients with COPD and CHF. The two patient groups were matched by oxygen-cost diagram scores, New York Heart Association functional classification scores, and modified Medical Research Council scores. COPD was defined as forced expired volume in one second and forced expired vital capacity ratio ≤0.7. CHF was defined as stable heart failure with an ejection fraction ≤49%. The healthy subjects were defined as those with no obvious history of chronic disease. Age, body mass index, cigarette consumption, lung function, and exercise capacity were different across the three groups. Muscle oxygenation and blood capacity were adjusted accordingly. Leg muscles had higher deoxygenation (HHb) and oxygenation (HbO2) and lower oxygen saturation (SmO2) than ventilatory muscles in all participants. The SmO2 of leg muscles was lower than that of ventilatory muscles because SmO2 was calculated as HbO2/(HHb+HbO2), and the HHb of leg muscles was relatively higher than the HbO2 of leg muscles. The healthy subjects had higher SmO2, the patients with COPD had higher HHb, and the patients with CHF had lower HbO2 in both muscle groups throughout the tests. The patients with CHF had lower SmO2 of ventilatory muscles than the patients with COPD at peak exercise (p < 0.01). We conclud that fd-NIRS can be used to discriminate tissue oxygenation of different musculatures and disease entities. More studies on interventions on ventilatory muscle oxygenation in patients with CHF and COPD are warranted.

Muscle and cerebral oxygenation during cycling in chronic obstructive pulmonary disease: A scoping review

“…In terms of placement of the NIRS optodes, 23 studies monitored NIRS parameters of the vastus lateralis (VL) and one study monitored the vastus medialis (VM). 31 Six studies evaluated the 7th intercostal muscle (IC), 17 , 21 , 37 , 39 , 49 , 50 one study monitored the serratus anterior (SA), 35 and one study examined the abdominal muscles, over the upper rectus abdominis. 21 Eight studies evaluated oxygenation of the cerebral cortex 9 , 13 , 36 , 41 – 43 , 47 , 50 and two studies examined the VL in conjunction with the cerebral cortex.…”

“…Of the studies that reported changes in oxygen extraction (HHb) of VL (n = 8), all reported a statistically significant increase in this value in response to cycling in COPD ( Table 2 ). Of the studies that monitored VL or VM StO2 (n = 11), most studies 2 , 20 , 31 , 35 , 36 , 38 , 39 , 45 , 48 reported a decrease in this value, whereas two studies reported unchanging levels of VL StO 2 ( Table 2 ). 5 , 37 …”

“…Patients with COPD demonstrated a shorter VL HHb time constant in one report 33 and the response magnitude of VL HHb relative to workload did not differ from healthy controls in one study. 35 Moreover, of the studies that measured StO 2 (n = 5), one study reported that VL StO 2 levels were lower in healthy controls compared to COPD patients, 20 and two studies observed a larger or more rapid decrease in response to exercise in healthy adults. 20 , 48 BFI was lower in limb muscles of COPD patients compared to healthy individuals.…”

Changes in Respiratory Muscle Strength Following Cardiac Rehabilitation for Prognosis in Patients with Heart Failure

“…Conversely, Habedank and colleagues showed that PI max , generally measured as a respiratory muscle function, was not an independent predictor of prognosis because it varied according to gender, BMI, and cachexia in patients with severe HFrEF [11]. A recent study has shown impaired respiratory muscle oxygenation during exercise in patients with HF, leading to breathlessness and decreased quality of life [23]. In the present study, the higher change in PI max was associated with lower respiratory muscle strength at the baseline.…”

Resting Dead Space Fraction as Related to Clinical Characteristics, Lung Function, and Gas Exchange in Male Patients with Chronic Obstructive Pulmonary Disease

“…Pre-test preparation was followed the standard guide and bronchodilators were not administered within 3 h for short-acting beta-agonists and 12 h for long-acting betaagonists before the tests. [27][28][29] FEV 1 , FVC, TLC, RV, and D L CO were measured using spirometry, body plethysmography, and the single-breath technique (MasterScreenTM Body; Carefusion, Wuerzburg, Germany), respectively, in accordance with the currently recommended standards by submit your manuscript | www.dovepress.com…”