Inspiratory muscle weakness contributes to exertional dyspnea in chronic thromboembolic pulmonary hypertension

PLoS One. 2018 Sep 27;13(9):e0204072. doi: 10.1371/journal.pone.0204072. eCollection 2018.

Abstract

Determination of potentially-reversible factors contributing to exertional dyspnea remains an unmet clinical need in chronic thromboembolic pulmonary hypertension (CTEPH). Therefore, we aimed to evaluate the influence of inspiratory muscle weakness (IMW) on exercise capacity and dyspnea during effort in patients with CTEPH. We performed a prospective cross-sectional study that included thirty-nine consecutive patients with CTEPH (48 ± 15 yrs, 61% female) confirmed by right heart catheterization that underwent an incremental cardiopulmonary exercise test, 6-minute walk test and maximum inspiratory pressure (MIP) measurement. MIP < 70%pred was found in 46% of patients. On a multiple linear regression analysis, MIP was independently associated with 6MWD and [Formula: see text]. Patients with MIP < 70% presented greater [Formula: see text] than those with MIP ≥ 70%. Additionally, they also presented stronger sensations of dyspnea throughout exercise, even when adjusted for ventilation. At rest and at different levels of exercise, mean inspiratory flow (VT/TI) was significantly higher in patients with MIP < 70%. In conclusion, IMW is associated with a rapid increase of dyspnea, higher inspiratory load and poor exercise capacity in patients with CTEPH.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chronic Disease
  • Dyspnea / etiology*
  • Dyspnea / physiopathology*
  • Exercise Test
  • Female
  • Humans
  • Hypertension, Pulmonary / complications*
  • Hypertension, Pulmonary / physiopathology*
  • Inhalation / physiology*
  • Male
  • Middle Aged
  • Muscle Weakness / complications*
  • Muscle Weakness / physiopathology*
  • Thromboembolism / complications
  • Thromboembolism / physiopathology*
  • Walk Test

Grants and funding

This research was supported by Fundação de Amparo à Pesquisa do Estado de São Paulo Grant #16/18497-7 to RPR. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.