Targeting the diaphragm via inspiratory muscle training or device-based stimulation is proposed as a novel treatment pathway for heart failure to improve hemodynamics and restore diaphragm strength.
Do therapies targeting the diaphragm (inspiratory muscle training or device-based stimulation) improve outcomes in patients with heart failure?
Targeting diaphragmatic dysfunction through inspiratory muscle training or device-based stimulation represents a potential novel therapeutic pathway for patients with heart failure.
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).
Salah et al. (Sat,) conducted a review in Heart failure. Targeting the diaphragm (inspiratory muscle training or device-based stimulation) was evaluated. Targeting the diaphragm via inspiratory muscle training or device-based stimulation is proposed as a novel treatment pathway for heart failure to improve hemodynamics and restore diaphragm strength.