Original Article

Echocardiographic Parameters Associated with Bendopnea in Patients with Systolic Heart Failure

Abstract

Target: Bendopnea, defined as dyspnea while bending, can be observed in patients with heart failure (HF). In this study, we investigated the frequency of this symptom in patients with systolic HF and its association with echocardiographic parameters.

Material and Methods: In this study, patients with left ventricular ejection fraction (LVEF) ≤45% and decompensated HF referred to our clinics were prospectively recruited. All patients were examined by cardiologists for collecting data on the presence of bendopnea and baseline characteristics. They also underwent electrocardiographic and echocardiographic examinations. All findings compared between patients with or without bendopnea.

Results: A total of 120 patients with a mean age of 65.19 ± 12.62 years were evaluated, and 74.8% were men. Bendopnea was observed in 44.2% of the patients. The etiology of HF was ischemic in most patients (81.9%), and the functional class of most patients (85.9%) was III or IV. The mortality rate at 6 months follow-up was comparable between patients with or without bendopnea (6% vs. 9.5%, p=0.507). The waist circumference (odds ratio [OR] 1.037, 95% confidence interval [CI] 1.005 – 1.070, p = 0.023), paroxysmal nocturnal dyspnea (OR 0.338, 95% CI 0.132 – 0.866, p = 0.024), and right atrium size (OR 1.084, 95% CI 1.002 – 1.172, p = 0.044) were associated with bendopnea.

Conclusions: Bendopnea can be frequently found among patients with systolic HF. This phenomenon is associated with obesity and baseline symptoms of patients and right atrium size upon echocardiographic examinations. It can help clinicians with the risk stratification of HF patients.

[1] Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018;137:e67-e492.
[2] Dahlström U. Epidemiology of Heart Failure. Heart Failure: Springer, 2019:3-36.
[3] Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circulation: Heart Failure 2013;6:606-19.
[4] Komanduri S, Jadhao Y, Guduru SS, Cheriyath P, Wert Y. Prevalence and risk factors of heart failure in the USA: NHANES 2013–2014 epidemiological follow-up study. Journal of Community Hospital Internal Medicine Perspectives 2017;7:15-20.
[5] Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. The Lancet 2014;383:999-1008.
[6] Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure 2016;18:891-975.
[7] McKelvie RS, Moe GW, Ezekowitz JA, Heckman GA, Costigan J, Ducharme A et al. The 2012 Canadian Cardiovascular Society heart failure management guidelines update: focus on acute and chronic heart failure. Canadian Journal of Cardiology 2013;29:168-81.
[8] Brandon N, Mehra MR. “Flexo-dyspnea”: a novel clinical observation in the heart failure syndrome. The Journal of Heart and Lung Transplantation 2013;32:844-45.
[9] Thibodeau JT, Turer AT, Gualano SK, Ayers CR, Velez-Martinez M, Mishkin JD et al. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart failure 2014;2:24-31.
[10] Baeza-Trinidad R, Mosquera-Lozano JD, Gomez-Del Mazo M, Arino-Perez de Zabalza I. Evolution of bendopnea during admission in patients with decompensated heart failure. European journal of internal medicine 2018;51:e23-e24.
[11] Brandon N. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart failure 2014;2:540.
[12] Niu F, Ma Q, Liu NR, Chen JH, Ren J. [Clinical value of bendopnea in chronic heart failure patients with reduced left ventricular ejection fraction]. Zhonghua xin xue guan bing za zhi 2017;45:126-29.
[13] Dominguez-Rodriguez A, Thibodeau JT, Abreu-Gonzalez P, Ayers CR, Jimenez-Sosa A, Aranda JM, Jr. et al. Association Between Bendopnea and Key Parameters of Cardiopulmonary Exercise Testing in Patients With Advanced Heart Failure. Journal of cardiac failure 2016;22:163-5.
[14] Baeza-Trinidad R, Mosquera-Lozano JD, El Bikri L. Assessment of bendopnea impact on decompensated heart failure. European journal of heart failure 2017;19:111-15.
[15] Baeza-Trinidad R, Isaula-Jimenez O, Peinado-Adiego C, Mosquera-Lozano JD. Prevalence of bendopnea in general population without heart failure. European journal of internal medicine 2018;50:e21-e22.
[16] Dominguez-Rodriguez A, Thibodeau JT, Ayers CR, Jimenez-Sosa A, Garrido P, Montoto J et al. Impact of bendopnea on postoperative outcomes in patients with severe aortic stenosis undergoing aortic valve replacement. Interactive cardiovascular and thoracic surgery 2018;27:808-12.
[17] Handa A, Agarwal R. Allergic bronchopulmonary aspergillosis causing bendopnea. Lung India : official organ of Indian Chest Society 2017;34:304-05.
[18] Cerón DMM, Rosa MLG, Jorge AJL, de Andrade Martins W, Mesquita ET, Freire MDC et al. Association of types of dyspnea including ‘bendopnea’with cardiopulmonary disease in primary care. Revista Portuguesa de Cardiologia (English Edition) 2017;36:179-86.
[19] Overbeck P. „Bendopnea “—Symptom der Herzinsuffizienz. CME 2014;11:24-24.
[20] Sajeev CG, Rajan Nair S, George B, Rajesh GN, Krishnan MN. Demographical and clinicopathological characteristics in heart failure and outcome predictors: a prospective, observational study. ESC heart failure 2017;4:16-22.
[21] Thibodeau JT, Jenny BE, Maduka JO, Divanji PH, Ayers CR, Araj F et al. Bendopnea and risk of adverse clinical outcomes in ambulatory patients with systolic heart failure. American heart journal 2017;183:102-07.
[22] Ekundayo OJ, Howard VJ, Safford MM, McClure LA, Arnett D, Allman RM et al. Value of orthopnea, paroxysmal nocturnal dyspnea, and medications in prospective population studies of incident heart failure. The American journal of cardiology 2009;104:259-64.
[23] Vijayakrishnan R, Steinhubl SR, Ng K, Sun J, Byrd RJ, Daar Z et al. Prevalence of heart failure signs and symptoms in a large primary care population identified through the use of text and data mining of the electronic health record. Journal of cardiac failure 2014;20:459-64.
[24] Mamas MA, Caldwell JC, Chacko S, Garratt CJ, Fath‐Ordoubadi F, Neyses L. A meta‐analysis of the prognostic significance of atrial fibrillation in chronic heart failure. European journal of heart failure 2009;11:676-83.
[25] Kotecha D, Piccini JP. Atrial fibrillation in heart failure: what should we do? European Heart Journal 2015;36:3250-57.
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IssueVol 17 No 4 (2022): J Teh Univ Heart Ctr QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jthc.v17i4.11611
Keywords
Heart failure, bendopnea, echocardiography, right atrium
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How to Cite
1.
Rostamzadeh A, Khademvatani K, Salehi S, Seyyed-mohammadzad M, Khani M, Hajahmadipour Rafsanjani M, Askari B, Rahimi B, Mostafavi Z, Hajizadeh R. Echocardiographic Parameters Associated with Bendopnea in Patients with Systolic Heart Failure. J Tehran Heart Cent. 2022;17(4):223-229.