第52回日本理学療法学術大会

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日本呼吸理学療法学会 » 口述発表

[O-RS-01] 口述演題(呼吸)01

2017年5月13日(土) 14:10 〜 15:10 A6会場 (幕張メッセ国際会議場 中会議室303)

座長:玉木 彰(兵庫医療大学大学院医療科学研究科), 座長:堀江 淳(京都橘大学健康科学部)

日本呼吸理学療法学会

[O-RS-01-1] Optimal cut-off value of inspiratory muscle strength to predict exercise intolerance in patients with chronic heart failure

HamazakiNobuaki1,2, Kentaro Kamiya1, Ryota Matsuzawa1, Kohei Nozaki1, Shinya Tanaka2, Emi Maekawa3, Takashi Masuda4 (1.Department of Rehabilitation, Kitasato University Hospital, 2.Kitasato University Graduate School of Medical Sciences, 3.Department of Cardiovascular Medicine, Kitasato University School of Medicine, 4.School of Allied Health Sciences, Kitasato University)

キーワード:Inspiratory Muscle Strength, Heart Failure, Exercise Intolerance

【Background】Inspiratory muscle weakness is present in 50% of chronic heart failure(CHF)patients and has been documented as an independent predictor for mortality. Although inspiratory muscle strength is thought to improve with inspiratory muscle training, the optimal cut-off value to determine the inspiratory muscle weakness has not been thoroughly evaluated in these patients. The aim of this study was to identify the cut-off value of inspiratory muscle strength to predict exercise intolerance in CHF patients.

【Methods】We studied 256 patients with CHF(60.3±12.0 years, 202 males)who performed cardiac rehabilitation during hospitalization and after hospital discharge. We measured maximal inspiratory pressure(PImax)as an inspiratory muscle strength using spirometer and calculated the percentage of predictive value(%PImax). We also measured peak oxygen uptake(VO2)during symptom-limited cardiopulmonary exercise test and determined the peak VO2<14 mL/kg/min as an exercise intolerance. All parameters were measured three months after hospital discharge. We identified the cut-off value of %PImax for peak VO2<14 mL/kg/min and analyzed the influence of that value on exercise intolerance.

【Results】Forty-two patients showed peak VO2<14 mL/min in this study. Analysis of receiver operating characteristic(ROC)curve revealed the %PImax as a significant predictor for peak VO2<14 mL/kg/min with an area under the ROC curve of 0.727(95%CI:0.642-0.812, P<0.001). The cut-off value of %PImax for peak VO2<14 mL/kg/min was 79.5%(sensitivity:0.685, specificity:0.690). When the patients' %PImax showed <79.5%, the odds ratio to predict peak VO2<14 mL/kg/min was 4.688(95%CI:1.928-11.401, P=0.001).

【Discussion】This study demonstrated that the cut-off value of %PImax to predict exercise intolerance was 79.5%. This cut-off value is helpful in determining the inspiratory muscle weakness and identifying the criteria for inspiratory muscle training in CHF patients.