Diaphragm dysfunction as a prognostic criterion of external respiratory impairment and necessary extracorporeal membrane oxygenation in patients with chronic heart failure

Objective. To estimate predictive value of diaphragm dysfunction regarding chronic heart failure (CHF) decompensation and the need for extracorporeal membrane oxygenation. Material and methods. The study included 90 subjects: 53 patients with stable CHF, 27 ones without CHF and 10 patients with decompensated CHF. Inclusion criterion for the study group was CHF NYHA class II-IV, for the group with decompensated CHF — onset of inotropic therapy. The control group included patients without CHF after radiofrequency ablation of pulmonary veins. Exclusion criteria for all groups were pulmonary diseases, morbid obesity, abdominal diseases and posthemorrhagic anemia. 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. Results. Prediction of diaphragm dysfunction may be based on diaphragm thickness: on the right — sensitivity 69.8%, specificity 96.3%; on the left — sensitivity 98.1%, specificity 77.8%; spirometry parameters: NIF — sensitivity 49%, specificity 74.7%; deep inhalation volume — sensitivity 60.4%, specificity 85.2%. Prediction of CHF decompensation may be based on spirometry parameters: NIF — sensitivity 80%, specificity 92.4%; deep inhalation volume — sensitivity 80%, specificity 79.2%. Prediction of ECMO initiation may be based on diaphragm thickness change on the right (sensitivity 100%, specificity 85.7%) and spirometry parameters (NIF — sensitivity 100%, specificity 100%; deep inhalation volume — sensitivity 100%, specificity 100%). Conclusion. Sonography of diaphragm and spirometry with occlusion tests may be informative in patients with CHF for predicting CHF decompensation and the need for ECMO.