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Surface respiratory electromyography and dyspnea in acute heart failure patients

Session Moderated Poster Session - Acute heart failure

Speaker Daniele Luiso

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Acute Heart Failure – Diagnostic Methods
  • Session type : Moderated Posters

Authors : D Luiso (Barcelona,ES), JA Villanueva (Barcelona,ES), LC Belarte-Tornero (Barcelona,ES), A Fort (Girona,ES), Z Blazquez-Bermejo (Madrid,ES), S Ruiz (Barcelona,ES), R Farre (Barcelona,ES), J Rigau (Barcelona,ES), J Marti-Almor (Barcelona,ES), N Farre (Barcelona,ES)

Authors:
D Luiso1 , JA Villanueva2 , LC Belarte-Tornero1 , A Fort3 , Z Blazquez-Bermejo4 , S Ruiz1 , R Farre2 , J Rigau5 , J Marti-Almor1 , N Farre1 , 1Hospital del Mar, Department of Cardiology - Barcelona - Spain , 2University of Barcelona, Biophysics and Bioengineering Unit, School of Medicine - Barcelona - Spain , 3University Hospital de Girona Dr. Josep Trueta, Department of Cardiology - Girona - Spain , 4University Hospital 12 de Octubre, Department of Cardiology - Madrid - Spain , 5Research, Development, and Innovation Department, Sibel S.A.U. - Barcelona - Spain ,

Citation:

Background/Introduction

Dyspnea is the most common symptom among hospitalized patients with heart failure (HF) and represents a therapeutic target. Despite this, there is no instrument that allows an objective evaluation of dyspnea. Studies performed in respiratory patients and mechanically ventilated patients suggest that the measurement of electromyographic (EMG) activity of the accessory muscles with surface electrodes correlates well with dyspnea and offers prognostic information. However, no data is available about the usefulness of this technique in HF.

Purpose

Our aim was to demonstrate a relationship between respiratory muscles EMG activity and dyspnea severity in acute HF patients.

Methods

Prospective and descriptive pilot study carried out in adult patients admitted for acute HF at the Emergency department. Measurements were carried out with a cardio-respiratory portable polygraph including nasal prongs to assess ventilation, pulse oximetry and EMG surface electrodes for measuring the activity of accessory (scalene and pectoralis minor) and main (diaphragm) respiratory muscles. After the sensors were in place, the patient was asked about his/her dyspnea sensation by means of the Likert 5 questionnaire. Then, data were recorded during 3 min of spontaneous breathing and after immediately asking the patient to breathe at maximum effort for several cycles. This assessment was carried out within the first 24 hours of admission, at 24 hours and at day 5. Clinicians were blinded to the EMG measurement, which was analyzed offline following patient discharge. An index to quantify the activity of each respiratory muscle was computed. A higher EMG index was expected as dyspnea intensity increased.

Results

The study was carried out in 28 patients. Dyspnea score with Likert 5 scale decreased along the three measured days: from a median 2 (1.5-3) in day 1 to a median 1 (1-2) in day 5 (p=0.011). Out of the total 84 possible measurements per muscle (28 patients x 3 days/patient), reliable EMG results were obtained in 74 cases (88%) for pectoralis minor and diaphragm and in 63 cases (75%) in scalene. Diaphragm and scalene EMG index showed a significant direct relationship with dyspnea score: the higher the Likert 5, the higher EMG index (p=0.002 and p=0.004 respectively). The pectoralis minor muscle did not show a significant linear relationship with Likert 5 scale (p=0.075).

Conclusion(s)

In our pilot study, diaphragm and scalene EMG activity was linearly associated with increasing severity of dyspnea. Surface respiratory EMG could be a useful tool to objectively quantify dyspnea in acute HF patients.

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