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Diaphragmatic ultrasound evaluation in acute heart failure: clinical and functional associations

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Abstract

Heart failure patients often experience respiratory symptoms due to diaphragmatic involvement, but the diaphragmatic motion in heart failure remains understudied. This research aimed to investigate the correlation between ultrasonographically assessed diaphragmatic motion and thickness with cardiac performance indexes in an emergency setting. Seventy-two acutely decompensated heart failure patients and 100 non-heart failure individuals were enrolled. Diaphragmatic motion and thickness were assessed via ultrasound. Cardiac and respiratory parameters were recorded, and regression analysis was performed. Heart failure patients exhibited reduced diaphragmatic motion at total lung capacity compared to controls, and an inverse association was found between motion and heart failure severity (NYHA stage). Diaphragmatic thickness was also higher in heart failure patients at tidal volume and total lung capacity. Notably, diaphragmatic motion inversely correlated with systolic pulmonary artery pressure. The study highlights diaphragmatic dysfunction in acutely decompensated heart failure, with reduced motion and increased thickness. These changes were associated with cardio-respiratory parameters, specifically systolic pulmonary artery pressure. Monitoring diaphragmatic motion via ultrasound may aid in evaluating heart failure severity and prognosis in emergency settings. Additionally, interventions targeting diaphragmatic function could improve heart failure management. Further research is warranted to enhance heart failure management and patient outcomes.

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Data availability

Considering privacy regulations in Italy and European Community our institution does not allow open data diffusion. We remain available for sharing selected data on reasonable request, given the authorization from institutional ethic committee.

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Acknowledgements

The authors wish to thank the scientific associations that promote research and dissemination of chest ultrasound: the research group in thoracic ultrasound in the elderly (GRETA) sponsored by the Italian Society of Geriatrics and Gerontology (SIGG) and the Campus Bio-Medico Ultrasound Research Group, in the person of its founder and inspirer Dr. Giovanni Galati. This research work is dedicated to the memory of Stefano Subioli, to whom all colleagues, residents, and patients pay tribute with affection and esteem.

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Authors and Affiliations

  1. Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Via Alvaro del Portillo, 200-00128, Rome, Italy

    Simone Scarlata, Evelyn Di Matteo, Panaiotis Finamore, Luigi Sogaro, Elisa Brando & Raffaele Antonelli Incalzi

  2. Research Unit of Internal Medicine, Università Campus Bio-Medico di Roma, Rome, Italy

    Simone Scarlata & Raffaele Antonelli Incalzi

  3. Geriatrics Unit, Ospedale Santa Maria della Scaletta, Imola, BO, Italy

    Giuseppe Perri

  4. Amaltea Private Practice, Rome, Italy

    Damiana Mancini

  5. Unit of Emergency and Critical Care Medicine, Fondazione Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy

    Tommaso Grandi, Francesco Travaglino & Federica Sambuco

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  1. Simone Scarlata
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  2. Evelyn Di Matteo
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  11. Raffaele Antonelli Incalzi
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Contributions

Conceptualization: SS, GP, and EDM; methodology: SS, GP, and PF; formal analysis and investigation: SS, GP, EDM, DM, LS, TG, and EB; writing—original draft preparation: SS, EDM, and PF; writing—review and editing: SS, EDM, PF, GP, DM, TG, EB, FT, FS, and RAI; funding acquisition: [N/A]; resources: [N/A]; supervision: SS, FT, FS, and RAI.

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Correspondence to Simone Scarlata.

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Scarlata, S., Di Matteo, E., Finamore, P. et al. Diaphragmatic ultrasound evaluation in acute heart failure: clinical and functional associations. Intern Emerg Med 19, 705–711 (2024). https://doi.org/10.1007/s11739-024-03531-9

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