AI Article Synopsis

  • Diaphragm atrophy can worsen breathing issues in heart failure patients, possibly linked to medication effects on the brain.
  • A study of 624 heart failure patients examined the respiratory benefits of central-acting vs peripheral-acting drugs through cardiopulmonary exercise tests (CPET).
  • Results showed that patients on central-acting drugs had improved respiratory function and potentially fewer adverse outcomes, highlighting their effectiveness in managing heart failure symptoms.

Article Abstract

Background: Diaphragm atrophy can contribute to dyspnea in patients with heart failure (HF) with its link to central neurohormonal overactivation. HF medications that cross the blood-brain barrier could act centrally and improve respiratory function, potentially alleviating diaphragmatic atrophy. Therefore, we compared the benefit of central- vs peripheral-acting HF drugs on respiratory function, as assessed by a single cardiopulmonary exercise test (CPET) and outcomes in HF patients.

Methods: A retrospective study was conducted of 624 ambulatory adult HF patients (80% male) with reduced left ventricular ejection fraction ≤ 40% and a complete CPET, followed at a single institution between 2001 and 2017. CPET parameters, and the outcomes all-cause death, a composite endpoint (all-cause death, need for left ventricular assist device, heart transplantation), and all-cause and/or HF hospitalizations, were compared in patients receiving central-acting (n = 550) vs peripheral-acting (n = 74) drugs.

Results: Compared to patients who receive peripheral-acting drugs, patients who receive central-acting drugs had better respiratory function (peak breath-by breath oxygen uptake [VO],  = 0.020; forced expiratory volume in 1 second [FEV1],  = 0.007), and ventilatory efficiency (minute ventilation / carbon dioxide production [VE/VCO], < 0.001; end-tidal carbon dioxide tension [PETCO],  = 0.015; and trend for forced vital capacity [FVC],  = 0.056). Many of the associations between the CPET parameters and drug type remained significant after multivariate adjustment. Moreover, patients receiving central-acting drugs had fewer composite events ( = 0.023), and HF hospitalizations ( = 0.044), although significance after multivariant correction was not achieved, despite the hazard ratio being 0.664 and 0.757, respectively.

Conclusions: Central-acting drugs were associated with better respiratory function as measured by CPET parameters in HF patients. This could extend to clinically meaningful composite outcomes and hospitalizations but required more power to be definitive in linking to drug effect. Central-acting HF drugs show a role in mitigating diaphragm weakness.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11150948PMC
http://dx.doi.org/10.1016/j.cjco.2024.01.003DOI Listing

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