'Bendopnea': A New Symptom to Help Spot Sicker HF Patients?

Marlene Busko

March 24, 2014

DALLAS, TX — Cardiologists in Texas have identified a new symptom to look for in patients with advanced heart failure—"bendopnea," which they define as "shortness of breath when bending forward."

Nearly a third of patients with advanced heart failure who were referred to their cardiac catheterization lab had bendopnea, according to a study published February 1, 2014 in the Journal of the American College of Cardiology: Heart Failure[1].

The study showed that "patients with heart failure who have bendopnea have hemodynamic profile C—meaning that they have higher [left ventricular] filling pressure and lower cardiac index," lead author Dr Jennifer T Thibodeau (University of Texas Southwestern Medical Center, Dallas) told heartwire . These are heart-failure patients who are sicker and likely require adjustment to their medications, or they might warrant further evaluation for advanced heart-failure therapy such as a ventricular assist device or a heart transplant, she noted.

"To our knowledge, this is the first new symptom of heart failure that has been identified in many years, and it finds patients who . . . have not only extra fluid but also weak hearts. This is something that patients can easily identify, and they can come to their doctor and say 'I'm having these symptoms.' " For physicians, this newly described symptom can improve the assessment of fluid status in patients with advanced heart failure.

Breathless When Bending

Being short of breath is common in patients with heart failure, and this can occur at different times, such as with exertion (dyspnea) or when lying flat (orthopnea), the researchers write. Many of their patients had told the researchers that they were short of breath when they bent down—a symptom that has not been previously characterized.

To investigate this, Thibodeau and colleagues prospectively enrolled 102 patients with systolic heart failure referred for right-heart catheterization. Most participants were white men aged 60 to 65 with NYHA functional classes 3 or 4.

Patients were asked to sit on a chair and bend forward as if they were putting on their shoes or socks. They were classed as having bendopnea if they reported shortness of breath within 30 seconds of bending.

All subjects had hemodynamic assessments when they were lying flat, and a subset of 46 subjects also had hemodynamic measurements when they were sitting and bending.

The researchers determined the patients' pulmonary capillary wedge pressure, or filling pressure of the left ventricle, and calculated the patients' cardiac index, a measure of the amount of blood being pumped to the rest of the body, Thibodeau explained.

Of the 102 subjects, 29 had bendopnea. These patients were more likely to also have other symptoms of decompensated heart failure, such as angina, dyspnea on exertion, orthopnea, and abdominal fullness. On physical examination, the only sign associated with bendopnea was an elevated jugular venous pressure.

The study suggests that that increased abdominal girth was not the primary cause of the shortness of breath when bending over. Although body-mass index was higher in patients with bendopnea, there were no differences in waist circumference or waist/hip ratio in those with or without bendopnea.

Subjects with bendopnea had higher ventricular filling pressures to start with and a lower cardiac index. Therefore, during bending they were more likely to reach a threshold pressure necessary to induce shortness of breath, the researchers suggest.

"Each symptom that we can identify can be useful in a full evaluation of our patients," Thibodeau said. "We hope that this will be replicated by other studies, and we are looking at this in other patient populations."

Thibodeau as no conflicts of interest. Disclosures for the coauthors are listed in the article.

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