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Correlation and compatibility between surface respiratory electromyography and transesophageal diaphragmatic electromyography measurements during treadmill exercise in stable patients with COPD

Authors Wu WL, Guan LL, Li XY, Lin L, Guo BP, Yang YQ, Liang ZY, Wang FY, Zhou LQ, Chen RC

Received 12 August 2017

Accepted for publication 2 October 2017

Published 6 November 2017 Volume 2017:12 Pages 3273—3280

DOI https://doi.org/10.2147/COPD.S148980

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Charles Downs

Peer reviewer comments 2

Editor who approved publication: Prof. Dr. Chunxue Bai

Weiliang Wu,1,* Lili Guan,1,* Xiaoying Li,2,* Lin Lin,1 Bingpeng Guo,1 Yuqiong Yang,1 Zhenyu Liang,1 Fengyan Wang,1 Luqian Zhou,1 Rongchang Chen1

1Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, 2Department of Respiratory Medicine, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China

*These authors contributed equally to this work


Purpose: To evaluate the compatibility and correlation between noninvasive surface respiratory electromyography and invasive transesophageal diaphragmatic electromyography measurements as facilitating indicators of neural respiratory drive (NRD) evaluation during treadmill exercise.
Patients and methods: Transesophageal diaphragmatic electromyogram activity (EMGdi,es) and surface inspiratory electromyogram (EMG) activity, including surface diaphragmatic EMG activity (EMGdi,sur), surface parasternal intercostal muscle EMG activity (EMGpara), and surface sternocleidomastoid EMG activity (EMGsc), were detected simultaneously during increasing exercise capacity in 20 stable patients with COPD. EMGdi,es, EMGdi,sur, EMGpara, and EMGsc were quantified using the root mean square (RMS) and were represented as RMSdi,es, RMSdi,sur, RMSpara, and RMSsc, respectively.
Results: There was a significant association between EMGdi,es and EMGdi,sur (r=0.966, p<0.01), EMGpara (r=0.967, p<0.01), and EMGsc (r=0.956, p<0.01) in the COPD patients during exercise. Bland-Altman plots showed that the lowest mean bias value was between EMGdi,es and EMGpara compared with the bias values between EMGdi,es and the other two EMG parameters. In comparing the estimation of EMGdi,es, we observed the lowest bias values (–1%) and the lowest limits of agreement values (–10% to –12%). Intraclass correlation coefficient (ICC) between EMGdi,es and EMGdi,sur was 0.978 (p<0.01), between EMGdi,es and EMGpara was 0.980 (p<0.01), and between EMGdi,es and EMGsc was 0.868 (p<0.01).
Conclusion: RMSdi,sur, RMSpara, and RMSsc could provide useful physiological markers of NRD in COPD. RMSpara shows the best compatibility and correlation with transesophageal diaphragmatic electromyography during treadmill exercise in stable patients with COPD.

Keywords: neural respiratory drive, transesophageal diaphragmatic EMG, surface diaphragmatic EMG, surface sternocleidomastoid EMG, surface parasternal intercostal muscle EMG

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