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C Rampulla - One of the best experts on this subject based on the ideXlab platform.

  • breathing pattern ventilatory drive and respiratory muscle strength in patients with chronic heart failure
    European Respiratory Journal, 1994
    Co-Authors: Nicolino Ambrosino, Cristina Opasich, Paola Crotti, Franco Cobelli, Luigi Tavazzi, C Rampulla
    Abstract:

    The purpose of this study was to evaluate whether chronic heart failure (CHF) may induce changes in breathing pattern and ventilatory neural drive. We studied 45 male inpatients with CHF, (25 patients in NYHA class II, 20 in class III) and 22 sex-matched post myocardial infarction patients without left ventricular dysfunction who served as controls. CHF patients underwent right heart catheterization and assessment of cardiac output by thermodilution technique. Patients and controls underwent evaluation of left ventricular ejection fraction by 2D echocardiography, spirometry, diffusion capacity, blood gases, breathing pattern, Mouth Occlusion Pressure and respiratory muscle strength determination. Results of CHF patients were compared to controls and evaluated for differences according to the degree in severity of functional impairment. CHF patients showed a slight reduction in lung volumes and in diffusion capacity. In CHF neural drive, as assessed by Mouth Occlusion Pressure (P0.1), was significantly increased in comparison to controls (P0.1 = 1.86 (0.7) and 1.4 (0.6) cmH2O in CHF and controls respectively). Analysis of breathing pattern showed only a slight yet significant increase in respiratory frequency while respiratory muscle strength, as assessed by measurement of maximal inspiratory and expiratory Pressures (MIP and MEP respectively) was slightly reduced (MIP = 79(27) and 104(28); MEP = 111(32) and 142(33) cmH2O respectively). Observed changes were more relevant in patients with advanced NYHA functional classes whereas no relationship among indices of cardiac and respiratory function was found. We conclude that chronic heart failure induces changes in neural ventilatory drive and respiratory muscle strength related to the severity of the disease.

Ralf Ewert - One of the best experts on this subject based on the ideXlab platform.

  • relation of respiratory muscle strength cachexia and survival in severe chronic heart failure
    Journal of Cachexia Sarcopenia and Muscle, 2013
    Co-Authors: Dirk Habedank, Joachim F Meyer, Roland Hetzer, Stefan D Anker, Ralf Ewert
    Abstract:

    Background Respiratory muscle (RM) function predicts prognosis in non-cachectic patients with chronic heart failure (CHF). We hypothesized that weakness of RM (maximum inspiratory Mouth Occlusion Pressure, Pimax) is a function of body mass index, and that outcome is more a function of BMI than of Pimax or ventilatory drive (P0.1). Subjects and methods We enrolled 249 CHF patients (11.2 % female, median age 54.2 years) at the German Heart Institute Berlin. Patients were in NYHA classes I/II/III/IV by n=16/90/108/35. All patients underwent tests of pulmonary function, RM (Pimax, P0.1), cardiopulmonary exercise testing (peakVO2, VE/VCO2-slope), and right heart catheterization. Results Mean follow-up time was 18 (1–36) months, 47 patients (18.9 %) died or underwent cardiac assist implantation. Pimax correlated weakly with BMI (r=0.19), peakVO2 (r=0.15), and FEV1 (r=0.34, all p<0.02), and was lower in females compared to males (3.9±1.7 vs. 6.6±2.7 kPa; p<0.001). P0.1 correlated with pulmonary Pressure (rho= 0.2; p<0.01) and peakVO2 (rho=−0.14; p<0.02). Neither Pimax [hazard ratio (HR) 0.98; confidence interval (CI) 0.88–1.08] nor P0.1 (HR 0.52; 0.06–4.6) predicted survival. Multivariate regression analysis revealed gender, BMI, and FEV1 as cofactors of Pimax ,w ith only BMI (HR 0.87; CI 0.80–0.95) predicting survival independently. The lowest quintile in BMI had the worst outcome (log-rank χ²=13.5, p=0.009). Summary In CHF patients including cachexia and NYHA IV, Pimax does not predict survival. Pimax depends on gender, BMI, FEV1, and peakVO2, with only BMI and peakVO2 predicting survival. The impaired Pimax in CHF might be a result of catabolism and weight loss and is not a predictive factor in itself.

  • ORIGINAL ARTICLE Relation of respiratory muscle strength, cachexia and survival in severe chronic heart failure
    2013
    Co-Authors: Dirk Habedank, Joachim F Meyer, Stefan D Anker, Ralf Ewert
    Abstract:

    Background Respiratory muscle (RM) function predicts prognosis in non-cachectic patients with chronic heart fail-ure (CHF). We hypothesized that weakness of RM (maxi-mum inspiratory Mouth Occlusion Pressure, Pimax) is a func-tion of body mass index, and that outcome is more a func-tion of BMI than of Pimax or ventilatory drive (P0.1). Subjects and methods We enrolled 249 CHF patients (11.2 % female, median age 54.2 years) at the German Heart Institute Berlin. Patients were in NYHA classes I/II/III/IV by n=16/90/108/35. All patients underwent tests of pulmonary function, RM (Pimax, P0.1), cardiopulmonary exercise testing (peakVO2, VE/VCO2-slope), and right heart catheterization. Results Mean follow-up time was 18 (1–36) months, 47 patients (18.9 %) died or underwent cardiac assist implanta-tion. Pimax correlated weakly with BMI (r=0.19), peakVO2 (r=0.15), and FEV1 (r=0.34, all p<0.02), and was lower in females compared to males (3.9±1.7 vs. 6.6±2.7 kPa; p<0.001). P0.1 correlated with pulmonary Pressure (rho= 0.2; p<0.01) and peakVO2 (rho=−0.14; p<0.02). Neither Pimax [hazard ratio (HR) 0.98; confidence interval (CI) 0.88–1.08] nor P0.1 (HR 0.52; 0.06–4.6) predicted sur-vival. Multivariate regression analysis revealed gender, BMI, and FEV1 as cofactors of Pimax, with only BMI (HR 0.87; CI 0.80–0.95) predicting survival independently. The lowest quintile in BMI had the worst outcome (log-rank χ=13.5, p=0.009). Summary In CHF patients including cachexia and NYHA IV, Pimax does not predict survival. Pimax depends on gender, BMI, FEV1, and peakVO2, with only BMI and peakVO2 predicting survival. The impaired Pimax in CHF might be a result of catabolism and weight loss and is not a predictive factor in itself

Joachim F Meyer - One of the best experts on this subject based on the ideXlab platform.

  • relation of respiratory muscle strength cachexia and survival in severe chronic heart failure
    Journal of Cachexia Sarcopenia and Muscle, 2013
    Co-Authors: Dirk Habedank, Joachim F Meyer, Roland Hetzer, Stefan D Anker, Ralf Ewert
    Abstract:

    Background Respiratory muscle (RM) function predicts prognosis in non-cachectic patients with chronic heart failure (CHF). We hypothesized that weakness of RM (maximum inspiratory Mouth Occlusion Pressure, Pimax) is a function of body mass index, and that outcome is more a function of BMI than of Pimax or ventilatory drive (P0.1). Subjects and methods We enrolled 249 CHF patients (11.2 % female, median age 54.2 years) at the German Heart Institute Berlin. Patients were in NYHA classes I/II/III/IV by n=16/90/108/35. All patients underwent tests of pulmonary function, RM (Pimax, P0.1), cardiopulmonary exercise testing (peakVO2, VE/VCO2-slope), and right heart catheterization. Results Mean follow-up time was 18 (1–36) months, 47 patients (18.9 %) died or underwent cardiac assist implantation. Pimax correlated weakly with BMI (r=0.19), peakVO2 (r=0.15), and FEV1 (r=0.34, all p<0.02), and was lower in females compared to males (3.9±1.7 vs. 6.6±2.7 kPa; p<0.001). P0.1 correlated with pulmonary Pressure (rho= 0.2; p<0.01) and peakVO2 (rho=−0.14; p<0.02). Neither Pimax [hazard ratio (HR) 0.98; confidence interval (CI) 0.88–1.08] nor P0.1 (HR 0.52; 0.06–4.6) predicted survival. Multivariate regression analysis revealed gender, BMI, and FEV1 as cofactors of Pimax ,w ith only BMI (HR 0.87; CI 0.80–0.95) predicting survival independently. The lowest quintile in BMI had the worst outcome (log-rank χ²=13.5, p=0.009). Summary In CHF patients including cachexia and NYHA IV, Pimax does not predict survival. Pimax depends on gender, BMI, FEV1, and peakVO2, with only BMI and peakVO2 predicting survival. The impaired Pimax in CHF might be a result of catabolism and weight loss and is not a predictive factor in itself.

  • ORIGINAL ARTICLE Relation of respiratory muscle strength, cachexia and survival in severe chronic heart failure
    2013
    Co-Authors: Dirk Habedank, Joachim F Meyer, Stefan D Anker, Ralf Ewert
    Abstract:

    Background Respiratory muscle (RM) function predicts prognosis in non-cachectic patients with chronic heart fail-ure (CHF). We hypothesized that weakness of RM (maxi-mum inspiratory Mouth Occlusion Pressure, Pimax) is a func-tion of body mass index, and that outcome is more a func-tion of BMI than of Pimax or ventilatory drive (P0.1). Subjects and methods We enrolled 249 CHF patients (11.2 % female, median age 54.2 years) at the German Heart Institute Berlin. Patients were in NYHA classes I/II/III/IV by n=16/90/108/35. All patients underwent tests of pulmonary function, RM (Pimax, P0.1), cardiopulmonary exercise testing (peakVO2, VE/VCO2-slope), and right heart catheterization. Results Mean follow-up time was 18 (1–36) months, 47 patients (18.9 %) died or underwent cardiac assist implanta-tion. Pimax correlated weakly with BMI (r=0.19), peakVO2 (r=0.15), and FEV1 (r=0.34, all p<0.02), and was lower in females compared to males (3.9±1.7 vs. 6.6±2.7 kPa; p<0.001). P0.1 correlated with pulmonary Pressure (rho= 0.2; p<0.01) and peakVO2 (rho=−0.14; p<0.02). Neither Pimax [hazard ratio (HR) 0.98; confidence interval (CI) 0.88–1.08] nor P0.1 (HR 0.52; 0.06–4.6) predicted sur-vival. Multivariate regression analysis revealed gender, BMI, and FEV1 as cofactors of Pimax, with only BMI (HR 0.87; CI 0.80–0.95) predicting survival independently. The lowest quintile in BMI had the worst outcome (log-rank χ=13.5, p=0.009). Summary In CHF patients including cachexia and NYHA IV, Pimax does not predict survival. Pimax depends on gender, BMI, FEV1, and peakVO2, with only BMI and peakVO2 predicting survival. The impaired Pimax in CHF might be a result of catabolism and weight loss and is not a predictive factor in itself

  • validity prognostic value and optimal cutoff of respiratory muscle strength in patients with chronic heart failure changes with beta blocker treatment
    European Journal of Preventive Cardiology, 2009
    Co-Authors: Lutz Frankenstein, M Nelles, Joachim F Meyer, Caroline Sigg, Dieter Schellberg, Andrew B Remppis, Hugo A Katus, Christian Zugck
    Abstract:

    BackgroundTraining studies frequently use maximum inspiratory Mouth Occlusion Pressure (PImax) as a therapeutic target and surrogate marker. For patients on β-blocker (BBL), prognostic data allowing this extrapolation do not exist. Furthermore, the effects of BBL, mainstay of modern chronic heart failure therapy, on respiratory muscle function remain controversial. Finally, no proper separate cutoff according to treatment exists.DesignProspective, observational inclusion of patients with stable systolic chronic heart failure and recording of 1 year and all-time mortality for endpoint analysis.MethodsIn 686 patients, 81% men, 494 patients on BBL, PImax was measured along with clinical evaluation. The median follow-up was 50 months (interquartile range: 26–75 months).ResultsPatients with or without BBL did not differ significantly for PImax, percentage of predicted PImax or other marker of disease severity. PImax was a significant (hazard ratio: 0.925; 95% confidence interval: 0.879–0.975; χ2: 8.62) marker ...

Eur Respir J - One of the best experts on this subject based on the ideXlab platform.

  • Printed in UK- all rights reserved Copyright ERS Journals Ltd 1994 European Respiratory Journal
    1993
    Co-Authors: Eur Respir J
    Abstract:

    Effect of nasal CPAP on ventilatory drive in normocapnic and hypercapnic patients with obstructive sleep apnoea syndrome C-C. Lin Effect of nasal CPAP on ventilatory drive in normocapnic and hypercapnic patients with obstructive sleep apnoea syndrome. C-C. Lin. ERS Journals Ltd 1994. ABSTRACT: The purpose of this study was to evaluate the effect of nasal contin-uous positive airway Pressure (CPAP) on the abnormal ventilatory drive in hyper-capnic patients with the obstructive sleep apnoea syndrome (OSAS). Six patients with hypercapnic OSAS (Group I) and 24 patients with eucapnic OSAS (Group II) were studied. All patients had arterial blood gas analysis, over-night sleep studies, and an assessment of ventilatory drive (progressive hyperoxic hypercapnic response and progressive isocapnic hypoxic ventilatory response) prior to and during nasal CPAP therapy (at 2 weeks and 1 month of treatment). Nasal CPAP effectively improved the hypopnoea/apnoea index in both groups (Group I: 87±14 vs 8±4; Group II: 63±17 vs 6±3). Both hypercapnic and hypoxic ventilatory drive before treatment were significantly impaired in Group I as compared to Group II. Both the slope and baseline level of the ventilatory response and the Mouth Occlusion Pressure (P0.1) improved significantly after 2 weeks of nasal CPAP therapy in Group I, with normalization of arterial carbon dioxide tension (PaCO2)(6.3±0.2 to 5.2±0.4 kPa). We conclude that it is possible to completely correct the abnormal ventilatory drive in hypercapnic OSAS patients within 14 days of initiating nasal CPAP therapy

  • Printed in UK- all rights reserved Copyright ©ERS Journals Ltd 1998 European Respiratory Journal
    2026
    Co-Authors: Eur Respir J
    Abstract:

    Maximum rate of change in oesophageal Pressure assessed from unoccluded breaths: an option where Mouth Occlusion Pressure is impractica

  • Copyright ©ERS Journals Ltd 1998 European Respiratory Journal
    2026
    Co-Authors: Eur Respir J
    Abstract:

    Mouth Occlusion Pressure, CO2 response and hypercapnia in severe chronic obstructive pulmonary disease M. Montes de Oca*, B.R. Celli** Patients with chronic obstructive pulmonary disease (COPD), may develop hypercapnia as the severity of the disease progresses. Several mechanisms have been pro-posed to explain CO2 retention in those patients. In a study of patients with COPD, BEGIN and GRASSINO [1] documented that inspiratory muscle weakness (as expressed by the maximal inspiratory Pressure (PI,max)) and the degree of airflow obstruction (as expressed by the forced expiratory volume in one second (FEV1)), were the most important determinants of resting arterial carbon dioxide tension (Pa,CO2). They postulated that chronic alveolar hypoventi-lation was probably the result of a breathing strateg

  • Copyright ©ERS Journals Ltd 1998 European Respiratory Journal
    2026
    Co-Authors: Eur Respir J
    Abstract:

    aa It is well known that alveolar ventilation is increased in hyperthyroidism [1]. Because the ventilatory responses to both hypercapnia and hypoxia are increased in hyperthy-roidism [2–4], it has generally been considered that thy-roid hormones could increase the sensitivity of the central and peripheral chemoreceptors. However, studies have fail-ed to show any relationship between the thyroid hormone levels and chemosensitivity [2–4]. To explain these obser-vations, it has been proposed that the apparent change in chemosensitivity may be partially affected by factors that do not directly affect chemoreception at the neural level. For a given stimulus level, the degree of ventilation depends not only on the nervous system response, but also on the state of the respiratory system [5]. Because lung compliance and respiratory muscle strength are low in hyperthyroid patients [6–8], ventilatory response must un-derestimate the level of respiratory neural drive. As venti-latory response may fail to reflect the true output at the respiratory centres in these patients, other measures, such as Mouth Occlusion Pressure (P0.1) response, are required [9]. To our knowledge, there has been no report on the P0.1 responses to CO2 and hypoxia in hyperthyroid patients. Not as well understood is the possible modulating role of basal metabolism in the peripheral chemosensitivity. Hyperthyroidism raises oxygen consumption [3, 6] and it has been shown that modifications in oxygen consumption may cause changes in the sensitivity to hypoxia [10–12]. Therefore, it is important to identify and describe the fac-tors that significantly alter the sensitivity to hypoxia in these patients. The present study was designed 1) to examine the base-line P0.1 and the P0.1 responses to CO2 and hypoxia in hy-perthyroid subjects before and after treatment; and 2) to examine the interactions between thyroid hormones, oxy-gen consumption and chemosensitivity

Joseph Milicemili - One of the best experts on this subject based on the ideXlab platform.

  • orthopnea and tidal expiratory flow limitation in chronic heart failure
    Chest, 2006
    Co-Authors: Roberto Torchio, Alberto Perboni, Carlo Gulotta, Pietro Grecolucchina, Luigina Avonto, Heberto Ghezzo, Joseph Milicemili
    Abstract:

    Background Tidal expiratory flow limitation (FL) is common in patients with acute left heart failure and contributes significantly to orthopnea. Whether tidal FL exists in patients with chronic heart failure (CHF) remains to be determined. Purpose To measure tidal FL and respiratory function in CHF patients and their relationships to orthopnea. Methods In 20 CHF patients (mean [± SD] ejection fraction, 23 ± 8%; mean systolic pulmonary artery Pressure [sPAP], 46 ± 18 mm Hg; mean age, 59 ± 11 years) and 20 control subjects who were matched for age and gender, we assessed FL, Borg score, spirometry, maximal inspiratory Pressure (Pimax), Mouth Occlusion Pressure 100 ms after the onset of inspiratory effort (P 0.1 ), and breathing pattern in both the sitting and supine positions. The Medical Research Council score and orthopnea score were also determined. Results In the sitting position, tidal FL was absent in all patients and healthy subjects. In CHF patients, Pimax was reduced, and ventilation and P 0.1 /Pimax ratio was increased relative to those of control subjects. In the supine position, 12 CHF patients had FL and 18 CHF patients claimed orthopnea with a mean Borg score increasing from 0.5 ± 0.7 in the sitting position to 2.7 ± 1.5 in the supine position in CHF patients. In contrast, orthopnea was absent in all control subjects. The FL patients were older than the non-FL patients (mean age, 63 ± 8 vs 53 ± 12 years, respectively; p 0.1 /Pimax ratio and the effective inspiratory impedance increased more in CHF patients than in control subjects. The best predictors of orthopnea in CHF patients were sPAP, supine Pimax, and the percentage change in inspiratory capacity (IC) from the seated to the supine position ( r 2 = 0.64; p Conclusions In sitting CHF patients, tidal FL is absent but is common supine. Supine FL, together with increased respiratory impedance and decreased inspiratory muscle force, can elicit orthopnea, whom independent indicators are sPAP, supine Pimax and change in IC percentage.