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. 2022 Mar 23:13:853469.
doi: 10.3389/fneur.2022.853469. eCollection 2022.

Thoracic Excursion Is a Biomarker for Evaluating Respiratory Function in Amyotrophic Lateral Sclerosis

Naohiko Iguchi  1 , Tomoo Mano  1   2 , Naoki Iwasa  1 , Maki Ozaki  1 , Nanami Yamada  1 , Naoya Kikutsuji  1 , Akira Kido  2 , Kazuma Sugie  1
Affiliations

Thoracic Excursion Is a Biomarker for Evaluating Respiratory Function in Amyotrophic Lateral Sclerosis

Naohiko Iguchi et al. Front Neurol. .

Abstract

Objective: To evaluate the usefulness of thoracic excursion as a biomarker in patients with amyotrophic lateral sclerosis (ALS).

Methods: We measured the forced the vital capacity (FVC), thoracic excursion, baseline-to-peak diaphragmatic compound muscle action potential (DCMAP) amplitude, diaphragm thickness at full inspiration (DTfi), Medical Research Council (MRC) sum score for muscle strength, and arterial partial pressures of oxygen and carbon dioxide and administered the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) and modified Medical Research Council (mMRC) Dyspnea Scale. The test-retest reliability of thoracic excursion was determined.

Results and conclusions: Thirty-four patients with ALS and 26 age- and sex-matched healthy participants were enrolled. Thoracic excursion measurement had excellent test-retest reliability (intraclass coefficient: 0.974). Thoracic excursion was more strongly correlated with FVC (r = 0.678, p < 0.001) than DCMAP amplitude (r = 0.501, p = 0.003) and DTfi (r = 0.597, p < 0.001). It was also correlated with ALSFRS-R score (r = 0.610, p < 0.001), MRC sum score (r = 0.470, p = 0.005), and mMRC Dyspnea Scale score (r = -0.446, p = 0.008) and was the most sensitive parameter for assessing dyspnea and FVC. Thoracic excursion decreased as FVC declined in the early and late stages, there were no differences in DCMAP amplitude and DTfi between the early and late stages, and ALSFRS-R score and MRC sum score decreased only in the late stage. Thoracic excursion was well correlated with respiratory function and is useful for predicting respiratory and general dysfunction in patients with ALS regardless of stage.

Keywords: amyotrophic lateral sclerosis; biomarker; pulmonary function test; respiratory function; thoracic excursion.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Thoracic excursion measurement. (A) The scenery of thoracic excursion measurement. (B) The wire of the measurement device. (C) The display of the application.
Figure 2
Figure 2
Thoracic excursion in patients with ALS. (A) The values of thoracic excursion in patients with ALS are significantly smaller than those in control patients. (B) Thoracic excursion measurement shows excellent test-retest reliability. ALS, amyotrophic lateral sclerosis.
Figure 3
Figure 3
Relationships between thoracic excursion and other neurophysiological parameters, FVC, and mMRC Dyspnea Scale score. (A–C) Relationships between thoracic excursion and DCMAP amplitude, DTfi, and FVC. Thoracic excursion shows a strong correlation with FVC (C) and moderate correlation with DCMAP amplitude (A) and DTfi (B). (D) Relationships between thoracic excursion and subjective dyspnea severity assessed using the mMRC Dyspnea Scale. Thoracic excursion is the most sensitive parameter for assessing subjective dyspnea. FVC, forced vital capacity; mMRC, modified Medical Research Council; DCMAP, diaphragmatic compound muscle action potential; DTfi, diaphragm thickness at full inspiration.
Figure 4
Figure 4
Relationships between respiratory function parameters and general condition. (A) Relationship between thoracic excursion and ALSFRS-R score. Thoracic excursion is strongly correlated with ALSFRS-R score. (B) Thoracic excursion is significantly lower in the patients in the mild respiratory dysfunction group whose ALSFRS-R score is <38 than those whose ALSFRS-R score is not <38. (C) Relationship between thoracic excursion and MRC sum score. Thoracic excursion is strongly correlated with MRC sum score. (D) Thoracic excursion is significantly lower in patients in the mild respiratory dysfunction group whose MRC sum score is <51 than in those whose MRC sum score is not <51. ALSFRS-R, amyotrophic lateral sclerosis functional rating scale-revised; MRC, medical research council.
Figure 5
Figure 5
Changes in thoracic excursion with FVC decline. Thoracic excursion decreases in both the early and late stage of FVC decline in patients with ALS. FVC, forced vital capacity; ALS, amyotrophic lateral sclerosis.
Figure 6
Figure 6
Changes in neurophysiological parameters and general condition with FVC decline. (A,B) DCMAP amplitude and DTfi decrease only in the early stage of FVC decline. (C,D) ALSFRS-R score and MRC sum score decrease only in the late stage of FVC decline. FVC, forced vital capacity; DCMAP, diaphragmatic compound motor-action potential; DTfl, diaphragm thickness at full inspiration; ALSFRS-R, amyotrophic lateral sclerosis functional rating scale-revised; MRC, medical research council.
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