Diaphragmatic function in cardiovascular disease: JACC review topic of the week

Salah, H. M., Goldberg, L. R., Molinger, J., Felker, G. M., Applefeld, W., Rassaf, T., Tedford, R. J., Mirro, M., Cleland, J. G.F. and Fudim, M. (2022) Diaphragmatic function in cardiovascular disease: JACC review topic of the week. Journal of the American College of Cardiology, 80(17), pp. 1647-1659. (doi: 10.1016/j.jacc.2022.08.760) (PMID:36265961)

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Abstract

In addition to the diaphragm’s role as the primary respiratory muscle, it also plays an under-recognized role in cardiac function. It serves as a pump facilitating venous and lymph return, modulating left ventricular afterload hemodynamics and pericardial pressures, as well as regulating autonomic tone. Heart failure (HF) is associated with diaphragmatic changes (ie, muscle fiber atrophy and weakness, increased ratio of type I to type II muscle fibers, and altered muscle metaboreflex) that lead to diaphragmatic dysfunction with subsequent symptomatic manifestations of HF. Herein, it is proposed that targeting the diaphragm in patients with HF via inspiratory muscle training or device-based stimulation can provide a novel treatment pathway for HF. Reviewed are several potential mechanisms through which therapies targeting the diaphragm can be beneficial in HF (ie, improving preload reserve, atrial and ventricular synchrony, and metaboreflex activity; reducing pericardial restraint; and restoring diaphragm strength).

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Cleland, Professor John
Authors: Salah, H. M., Goldberg, L. R., Molinger, J., Felker, G. M., Applefeld, W., Rassaf, T., Tedford, R. J., Mirro, M., Cleland, J. G.F., and Fudim, M.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:Journal of the American College of Cardiology
Publisher:Elsevier
ISSN:0735-1097
ISSN (Online):1558-3597
Published Online:17 October 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in Journal of the American College of Cardiology 80(17):1647-1659
Publisher Policy:Reproduced in accordance under a Creative Commons License

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