Bendopnea: Association With Echocardiographic Features and Clinical Outcomes in Elderly Patients With Chronic Heart Failure

Abstract

Aim:to assess the prevalence of bendopnea and association of this symptom with clinical, laboratory and echocardiographic features, clinical outcomes during 2 years of follow­up in ambulatory elderly patients with chronic heart failure (CHF).Materials and methods.We conducted an open, prospective, non­randomized study of 80 ambulatory patients aged ≥60 years admitted with heart failure II–IV NYHA class CHF. Baseline survey included physical examination, estimation of Charlson comorbidity index, echocardiography and laboratory tests. Bendopnea was considered when shortness of breath occurred within 30 sec of sitting on a chair and bending forward. Mean follow­up was 26.6±11.0 months.Results.Bendopnea was present in 38.8 % patients. All these patients complained of shortness of breath during physical exertion and 45.2 % of them had orthopnea. Bendopnea was associated with the male gender (odds ratio [OR] 11.8, 95 % confidence interval [CI] 4.04–34.8, p<0.001), severity of the clinical status (ШОКС [shocks] scale score) (OR 1.78, 95 % CI 1.29–2.38, p<0.001), Charlson comorbidity index (OR 1.29, 95 % CI 1.07–1.52, p=0.007), coronary heart disease (OR 26.6, 95 % CI 3.34–21.3, p=0.002), history of myocardial infarction (OR 13.9, 95 % CI 4.2–46.6, p<0.001), left ventricular (LV) aneurysm (OR 13.3, 95 % CI 2.69–65.9, p=0.002), increased indexed LV end­systolic diameter (OR 8.2, 95 % CI 1.9–34.1, p=0.004), left atrial size (OR 4.3, 95 % CI 1,4–12.5, p=0.008), indexed LV end­systolic volume (OR 1.32, 95 % CI 1.07–1.64, p=0.010), pulmonary artery systolic pressure (OR 1.26, 95 % 1.03–1.45, p=0.002), high levels of NT­proBNP (OR 1.0, 95 % CI 1.0–1.002, p=0.055), creatinine (OR 1.04, 95 % CI 1.02–1.07, p=0.001), uric acid (OR 1.006, 95 % CI 1.002–1.011, p=0.004); hospitalizations (OR 7.61, 95 % 2.04–28.4, p=0.003), and patient’s mortality (OR 5.63, 95 % CI 1.94–16.4, p=0.001). Multifactorial analysis confirmed association of bendopnea with severity of clinical status (OR 1.70, 95 % CI 1.04–2.8, p=0.033), increased left atrial size (OR 5.67, 95 % CI 2.75–21.32, p=0.029) and Charlson comorbidity index (OR 1.17, 95 % CI 1.04–2.80, p=0.050). During follow­up 51.6 and 12.2 % of patients died among those with and without bendopnea, respectively (OR 4.22, 95 % CI 1.85–9.9, p<0.001).Conclusion. Bendopnea is associated with an adverse hemodynamic profile and prognosis, what allows to consider this symptom as a reliable marker of CHF severity.

Diagnostic Value and Clinical Performance of Cardiac Ultrasound in Patients with Chronic Heart Failure with Hypertension

“…Ultrasound technology has been widely used in clinical practice, and cardiac ultrasound provides a comprehensive evaluation of the cardiac function by effectively displaying detailed information such as cardiac data and blood flow data of the examined subjects. The use of cardiac ultrasound to perform effective examinations in patients with hypertension and CHF can accurately determine the myocardial lesions, cardiac atrioventricular cavity size, ventricular wall thickness and septal damage, and other relevant indicators, which facilitate the diagnosis and treatment of the disease [ 18 ]. It has been shown that cardiac ultrasound, as an important modality for diagnosing the cardiac function, features benefits such as less damage, simplicity of operation, and repeatability, which provide higher sensitivity versus electrocardiographic results and remarkably improve the accuracy of disease diagnosis [ 19 , 20 ].…”

The relationship between bendopnea and clinical outcomes in stable pulmonary arterial hypertension outpatients

“…If the number of events or patients was high in our study, all-cause mortality at 3 months could also be different. Larina et al have recently showed that bendopnea was associated with worse echocardiographic characteristics and clinical outcomes in elderly ambulatory patients with HF (16). Bendopnea was present 38.8% of their study patients (16).…”

“…Bendopnea was present 38.8% of their study patients (16). They demonstrated that bendopnea was an independent predictor of mid-term HF-related rehospitalization and mortality (16). Dominguez-Rodriguez et al have been demonstrated that preoperative presence of bendopnea in severe AS patients was associated with higher postoperative clinical events (15).…”

“…Larina et al have recently showed that bendopnea was associated with worse echocardiographic characteristics and clinical outcomes in elderly ambulatory patients with HF (16). Bendopnea was present 38.8% of their study patients (16). They demonstrated that bendopnea was an independent predictor of mid-term HF-related rehospitalization and mortality (16).…”

Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure

“…1,2 Although bendopnea has been associated with advanced HF symptoms, 3,4 there are conflicting results about its prognostic performance in different HF scenarios. 3,[5][6][7] Furthermore, the perception of shortness of breath when bending over to tie a shoe or putting socks on is subjective and not uncommon in individuals who do not have HF as a diagnosis (e.g. obese, elderly).…”