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2026№6

Current possibilities for assessing and correcting the structural and functional condition of the diaphragm in patients with chronic heart failure

DOI
https://dx.doi.org/10.18565/therapy.2026.6.153-160

K.N. Tkachenko, M.S. Tyuryupov, P.G. Shakhnovich, D.V. Cherkashin, K.V. Matyushenko, D.S. Bogdanov

1) S.M. Kirov Military Medical Academy, Saint Petersburg, Russian Federation; 2) 442nd Military Clinical Hospital, Saint Petersburg, Russian Federation; 3) Central Clinical Hospital with a polyclinic of the Executive Office of the President of the Russian Federation, Moscow, Russian Federation
Abstract. Shortness of breath and decreased exercise tolerance are common manifestations of chronic heart failure (CHF), which may be arising due to diaphragmatic dysfunction. The aim of the review is to summarize data on the structural and functional condition of the diaphragm in case of CHF, its role in the development of disease symptoms, and diagnostic and treatment methods. A search for relevant sources was performed in PubMed/MEDLINE and eLIBRARY.RU; of the 263 publications found, 39 were included in the qualitative analysis. Most studies have shown a link between diaphragmatic dysfunction and the severity of dyspnea and reduced exercise tolerance. The pathophysiological mechanisms of diaphragmatic dysfunction, diagnostic capabilities of diaphragmatic ultrasound examination, determination of maximum inspiratory pressure, spirometry, and cardiopulmonary exercise testing, as well as their prognostic value, are discussed. Estimation of diaphragmatic function can complete the standard examination of patients having CHF.

Keywords

chronic heart failure
diaphragm
respiratory muscles
ultrasound examination
cardiopulmonary exercise testing
Full text (in Russian)

References

  1. Поляков Д.С., Фомин И.В., Беленков Ю.Н., Мареев В.Ю., Агеев Ф.Т., Артемьева Е.Г. с соавт. Хроническая сердечная недостаточность в Российской Федерации: что изменилось за 20 лет наблюдения? Результаты исследования ЭПОХА-ХСН. Кардиология. 2021;61(4):4–14. [Polyakov DS, Fomin IV, Belenkov YuN, Mareev VYu, Ageev FT, Artemyeva EG, et al. Chronic heart failure in the Russian Federation: What has changed over 20 years of follow-up? Results of the EPOCHA-CHF study. Kardiologiya = Cardiology. 2021;61(4):4–14 (In Russ.)].

    EDN: WSZNFS. https://doi.org/10.18087/cardio.2021.4.n1628

  2. Sieck GC, Ferreira LF, Reid MB, Mantilla CB. Mechanical properties of respiratory muscles. Compr Physiol. 2013;3(4):1553–67.

    PMID: 24265238. PMCID: PMC3977503. https://doi.org/10.1002/cphy.c130003

  3. Woods PR, Olson TP, Frantz RP, Johnson BD. Causes of breathing inefficiency during exercise in heart failure. J Card Fail. 2010;16(10):835–42.

    PMID: 20932466. PMCID: PMC2953473. https://doi.org/10.1016/j.cardfail.2010.05.003

  4. Baekey DM, Molkov YI, Paton JF, Rybak IA, Dick TE. Effect of baroreceptor stimulation on the respiratory pattern: Insights into respiratory-sympathetic interactions. Respir Physiol Neurobiol. 2010;174(1–2):135–45.

    PMID: 20837166. PMCID: PMC3691868. https://doi.org/10.1016/j.resp.2010.09.006

  5. Dempsey JA, Romer L, Rodman J, Miller J, Smith C. Consequences of exercise-induced respiratory muscle work. Respir Physiol Neurobiol. 2006;151(2–3):242–50.

    PMID: 16616716. https://doi.org/10.1016/j.resp.2005.12.015

  6. Miller JD, Smith CA, Hemauer SJ, Dempsey JA. The effects of inspiratory intrathoracic pressure production on the cardiovascular response to submaximal exercise in health and chronic heart failure. Am J Physiol Heart Circ Physiol. 2007;292(1):H580–92.

    PMID: 16997896. https://doi.org/10.1152/ajpheart.00211.2006

  7. Nakagawa NK, Diz MA, Kawauchi TS, de Andrade GN, Umeda IIK, Murakami FM, et al. Risk factors for inspiratory muscle weakness in chronic heart failure. Respir Care. 2020;65(4):507–16.

    PMID: 31822596. https://doi.org/10.4187/respcare.06766

  8. Hammond MD, Bauer KA, Sharp JT, Rocha RD. Respiratory muscle strength in congestive heart failure. Chest. 1990;98(5):1091–94.

    PMID: 2225950. https://doi.org/10.1378/chest.98.5.1091

  9. Filusch A, Ewert R, Altesellmeier M, Zugck C, Hetzer R, Borst MM, et al. Respiratory muscle dysfunction in congestive heart failure – the role of pulmonary hypertension. Int J Cardiol. 2011;150(2):182–85.

    PMID: 20444510. https://doi.org/10.1016/j.ijcard.2010.04.006

  10. Walsh JT, Andrews R, Johnson P, Phillips L, Cowley AJ, Kinnear WJ. Inspiratory muscle endurance in patients with chronic heart failure. Heart. 1996;76(4):332–36.

    PMID: 8983680. PMCID: PMC484545. https://doi.org/10.1136/hrt.76.4.332

  11. Chiappa GR, Roseguini BT, Vieira PJ, Alves CN, Tavares A, Winkelmann ER, et al. Inspiratory muscle training improves blood flow to resting and exercising limbs in patients with chronic heart failure. J Am Coll Cardiol. 2008;51(17):1663–71.

    PMID: 18436118. https://doi.org/10.1016/j.jacc.2007.12.045

  12. Chua TP, Anker SD, Harrington D, Coats AJ. Inspiratory muscle strength is a determinant of maximum oxygen consumption in chronic heart failure. Br Heart J. 1995;74(4):381–85.

    PMID: 7488451. PMCID: PMC484043. https://doi.org/10.1136/hrt.74.4.381

  13. Nishimura Y, Maeda H, Tanaka K, Nakamura H, Hashimoto Y, Yokoyama M. Respiratory muscle strength and hemodynamics in chronic heart failure. Chest. 1994;105(2):355–59.

    PMID: 8306727. https://doi.org/10.1378/chest.105.2.355

  14. Frankenstein L, Nelles M, Meyer FJ, Sigg C, Schellberg D, Remppis BA, et al. Validity, prognostic value and optimal cutoff of respiratory muscle strength in patients with chronic heart failure changes with beta-blocker treatment. Eur J Cardiovasc Prev Rehabil. 2009;16(4):424–29.

    PMID: 19474739. https://doi.org/10.1097/HJR.0b013e3283030a7e

  15. Hamazaki N, Kamiya K, Matsuzawa R, Nozaki K, Ichikawa T, Tanaka S, et al. Prevalence and prognosis of respiratory muscle weakness in heart failure patients with preserved ejection fraction. Respir Med. 2020;161:105834.

    PMID: 31783270. https://doi.org/10.1016/j.rmed.2019.105834

  16. Katayıfcı N., Boşnak Guclu M. Inspiratory muscle weakness further impairs exercise capacity and respiratory functions and increases dyspnea perception in patients with heart failure. Sci Rep. 2025;15(1):32229.

    PMID: 40890240. PMCID: PMC12402243. https://doi.org/10.1038/s41598-025-16492-6

  17. Hamazaki N, Masuda T, Kamiya K, Matsuzawa R, Nozaki K, Maekawa E, et al. Respiratory muscle weakness increases dead-space ventilation ratio aggravating ventilation-perfusion mismatch during exercise in patients with chronic heart failure. Respirology. 2019;24(2):154–61.

    PMID: 30426601. https://doi.org/10.1111/resp.13432

  18. Yamada K, Kinugasa Y, Sota T, Miyagi M, Sugihara S, Kato M, Yamamoto K. Inspiratory muscle weakness is associated with exercise intolerance in patients with heart failure with preserved ejection fraction: A preliminary study. J Card Fail. 2016;22(1):38–47.

    PMID: 26505812. https://doi.org/10.1016/j.cardfail.2015.10.010

  19. Miyagi M, Kinugasa Y, Sota T, Yamada K, Ishisugi T, Hirai M, et al. Diaphragm muscle dysfunction in patients with heart failure. J Card Fail. 2018;24(4):209–16.

    PMID: 29289723. https://doi.org/10.1016/j.cardfail.2017.12.004

  20. Kagiyama N, Kamiya K, Toki M, Saito H, Iwata K, Matsue Y, et al. Prognostic impact of diaphragm thickness in geriatric patients with heart failure: The SONIC-HF multicenter registry. JACC Cardiovasc Imaging. 2025;18(3):389–91.

    PMID: 39708042. https://doi.org/10.1016/j.jcmg.2024.09.012

  21. de Boer WS, Parlevliet KL, Kooistra LA, Koster D, Nieuwenhuis JA, Edens MA, et al. Ultrasound as diagnostic tool in diaphragm dysfunction: A prospective construct validity study. Respir Med. 2025;241:108083.

    PMID: 40187575. https://doi.org/10.1016/j.rmed.2025.108083

  22. Andriopoulou M, Dimaki N, Kallistratos MS, Chamodraka E, Jahaj E, Vassiliou AG, et al. Skeletal muscle alterations and exercise intolerance in heart failure with preserved ejection fraction patients: Ultrasonography assessment of diaphragm and quadriceps. Eur J Heart Fail. 2022;24(4):729–31.

    PMID: 35229401. https://doi.org/10.1002/ejhf.2462. Erratum in: Eur J Heart Fail. 2024;26(1):193. https://doi.org/10.1002/ejhf.3123

  23. Nava S, Larovere MT, Fanfulla F, Navalesi P, Delmastro M, Mortara A. Orthopnea and inspiratory effort in chronic heart failure patients. Respir Med. 2003;97(6):647–53.

    PMID: 12814149. https://doi.org/10.1053/rmed.2003.1495

  24. Rozados da Conceicao C, Krannich A, Zach V, Pinto R, Deichl A, Feuerstein A, et al. Cardiopulmonary exercise testing as a prognosis-assessing tool in heart failure with preserved ejection fraction. ESC Heart Fail. 2025;12(3):2098–106.

    PMID: 39823134. PMCID: PMC12055351. https://doi.org/10.1002/ehf2.15219

  25. Borghi-Silva A, Carrascosa C, Oliveira CC, Barroco AC, Berton DC, Vilaca D, et al. Effects of respiratory muscle unloading on leg muscle oxygenation and blood volume during high-intensity exercise in chronic heart failure. Am J Physiol Heart Circ Physiol. 2008;294(6):H2465–72.

    PMID: 18375714. https://doi.org/10.1152/ajpheart.91520.200

  26. Olson TP, Joyner MJ, Dietz NM, Eisenach JH, Curry TB, Johnson BD. Effects of respiratory muscle work on blood flow distribution during exercise in heart failure. J Physiol. 2010;588(Pt 13):2487–501.

    PMID: 20457736. PMCID: PMC2915522. https://doi.org/10.1113/jphysiol.2009.186056

  27. Smith JR, Berg JD, Curry TB, Joyner MJ, Olson TP. Respiratory muscle work influences locomotor convective and diffusive oxygen transport in human heart failure during exercise. Physiol Rep. 2020;8(12):e14484.

    PMID: 32562374. PMCID: PMC7305241. https://doi.org/10.14814/phy2.14484

  28. Nascimento PMC, Ribeiro ML, Lourenco BN, Villacorta H, Jorge AJL, Rocha NN, et al. Dyspnea and heart failure: The role of the diaphragm. Curr Cardiol Rev. 2025;21(3):e1573403X330739.

    PMID: 39844545. PMCID: PMC12172216. https://doi.org/10.2174/011573403X330739241216185852

  29. Jesus F, Hazenberg A, Duiverman M, Wijkstra P. Diaphragm dysfunction: How to diagnose and how to treat? Breathe (Sheff). 2025;21(1):240218.

    PMID: 40012556. PMCID: PMC11864072. https://doi.org/10.1183/20734735.0218-2024

  30. Yang M, Huang W, Luo Z, Zhang X, Su J, Yu P. Effect of inspiratory muscle training in patients with chronic heart failure: A systematic review and meta-analysis of randomized controlled trials. J Thorac Dis. 2025;17(8):6242–53.

    PMID: 40950861. PMCID: PMC12433052. https://doi.org/10.21037/jtd-2025-519

  31. Costanzo MR, Ponikowski P, Coats A, Javaheri S, Augostini R, Goldberg LR, et al.; remede® System Pivotal Trial Study Group. Phrenic nerve stimulation to treat patients with central sleep apnoea and heart failure. Eur J Heart Fail. 2018;20(12):1746–54.

    PMID: 30303611. PMCID: PMC6607512. https://doi.org/10.1002/ejhf.1312

  32. Badr MS, Khayat RN, Allam JS, Hyer S, Mustafa RA, Naughton MT, et al. Treatment of central sleep apnea in adults: An American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2025;21(12):2181–91.

    PMID: 40820608. PMCID: PMC12670627 (available on 2026-12-01). https://doi.org/10.5664/jcsm.11858

  33. Goldberg LR, Mirro M, Becker G, Shaburishvili T, Fudim M. Synchronized diaphragmatic stimulation for the treatment of HFrEF – a review. Heart Fail Rev. 2025;30(5):1035–43.

    PMID: 40434588. PMCID: PMC12296808. https://doi.org/10.1007/s10741-025-10525-y

  34. Jorbenadze A, Young R, Shaburishvili T, Demyanchuk V, Buriak R, Todurov B, et al. Synchronized diaphragmatic stimulation for heart failure using the VisONE system: A first-in-patient study. ESC Heart Fail. 2022;9(4):2207–14.

    PMID: 35619238. PMCID: PMC9288796. https://doi.org/10.1002/ehf2.13984

  35. Arango-Cortes ML, Giraldo-Cadavid LF, Latorre Quintana M, Forero-Cubides JD, Gonzalez-Bermejo J. Diaphragm pacing compared with mechanical ventilation in patients with chronic respiratory failure caused by diaphragmatic dysfunction: A systematic review and meta-analysis. Expert Rev Respir Med. 2024;18(12):1101–11.

    PMID: 39639468. https://doi.org/10.1080/17476348.2024.2421846

  36. Tanriverdi A, Savci S, Ozcan Kahraman B, Odaman H, Ozpelit E, Senturk B, et al. Effects of high intensity interval-based inspiratory muscle training in patients with heart failure: A single-blind randomized controlled trial. Heart Lung. 2023;62:1–8.

    PMID: 37285766. https://doi.org/10.1016/j.hrtlng.2023.05.011

  37. Palau P, Dominguez E, Nunez E, Schmid JP, Vergara P, Ramon JM, et al. Effects of inspiratory muscle training in patients with heart failure with preserved ejection fraction. Eur J Prev Cardiol. 2014;21(12):1465–73.

    PMID: 23864363. https://doi.org/10.1177/2047487313498832

  38. Palau P, Dominguez E, Lopez L, Ramon JM, Heredia R, Gonzalez J, et al. Inspiratory muscle training and functional electrical stimulation for treatment of heart failure with preserved ejection fraction: The TRAINING-HF trial. Rev Esp Cardiol (Engl Ed). 2019;72(4):288–97.

    PMID: 29551699. https://doi.org/10.1016/j.rec.2018.01.010

  39. Palau P, Domínguez E, Ramon JM, Lopez L, Briatore AE, Tormo JP, et al. Home-based inspiratory muscle training for management of older patients with heart failure with preserved ejection fraction: Does baseline inspiratory muscle pressure matter? Eur J Cardiovasc Nurs. 2019;18(7):621–27.

    PMID: 31148459. https://doi.org/10.1177/1474515119855183

About the Authors

Konstantin N. Tkachenko, MD, PhD (Medicine), senior lecturer at the Department of naval therapy, S.M. Kirov Military Medical Academy, Saint Petersburg, Russian Federation.
E-mail: tknmd@yandex.ru
ORCID: https://orcid.org/0000-0002-3432-0278. eLibrary SPIN: 7098-4783
Mark S. Tyuryupov, MD, PhD (Medicine), senior resident of the Department of therapy (20 beds), 442nd Military Clinical Hospital, Saint Petersburg, Russian Federation.
E-mail: tyuryupmark@yandex.ru
ORCID: https://orcid.org/0000-0002-8366-0594. eLibrary SPIN: 2886-7181
Pavel G. Shakhnovich, MD, Dr. Sci. (Medicine), head of the Center for specialized medical care in therapy, Central Clinical Hospital with a polyclinic of the Executive Office of the President of the Russian Federation, Moscow, Russian Federation.
E-mail: p_shakhnovich@mail.ru
ORCID: https://orcid.org/0000-0002-6872-5310. eLibrary SPIN: 3164-6277.
Dmitry V. Cherkashin, MD, Dr. Sci. (Medicine), professor, Honored Doctor of the Russian Federation, head of the Department and clinic of naval therapy, S.M. Kirov Military Medical Academy, Saint Petersburg, Russian Federation.
E-mail: cherkashin_dmitr@mail.ru
ORCID: https://orcid.org/0000-0003-1363-6860. eLibrary SPIN: 2781-9507
Konstantin V. Matyushenko, MD, PhD (Medicine), senior lecturer at the Department of naval therapy, S.M. Kirov Military Medical Academy, Saint Petersburg, Russian Federation.
E-mail: kvmat@mail.ru
ORCID: https://orcid.org/0000-0002-7399-3694. eLibrary SPIN: 8656-9671
Dmitry S. Bogdanov, MD, PhD (Medicine), lecturer at the Department of naval therapy, S.M. Kirov Military Medical Academy, Saint Petersburg, Russian Federation.
E-mail: dimbog@mail.ru
ORCID: https://orcid.org/0009-0004-7765-1693. eLibrary SPIN: 5070-8537

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