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Novel advanced HF symptom useful for noninvasive hemodynamic assessment
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Bendopnea, or shortness of breath when bending forward, is a novel symptom of advanced HF, and awareness of this symptom can improve the noninvasive evaluation of patients with HF, according to recent findings.
In a single-center, prospective observational study, researchers evaluated 102 patients with systolic HF referred for right heart catheterization at the University of Texas Southwestern Medical Center between June 2010 and May 2012. Before catheterization, participants underwent physical examination, and data were collected pertaining to demographics, medical history, cardiac medications, etiology of cardiomyopathy, peak oxygen consumption, left ventricular ejection fraction and NYHA heart function classification.
The presence of bendopnea, which the researchers characterized as shortness of breath experienced within 30 seconds of bending forward, was determined by having each participant sit in a chair and bend forward at the waist. An investigator timed the interval to shortness of breath as indicated by the participant. Additionally, a subset of 46 participants underwent hemodynamic evaluation while sitting upright in a chair, and also while sitting and bending forward at the waist.
The researchers observed bendopnea in 28% of study participants, with a median time to onset of 8 seconds. Participants who had bendopnea had higher recumbent right atrial pressure (P=.001) and wedge pressure (P=.0004) than those without bendopnea, but the two groups had similar cardiac indexes (P=.2) Researchers observed an increase in both right arterial pressure and wedge pressure upon bending among participants with and without bendopnea, whereas cardiac index did not change.
Patients with bendopnea were more likely to have a prone hemodynamic profile indicative of increased pulmonary capillary wedge pressure with low cardiac index than those without bendopnea (55% of patients vs. 16%; P<.001). However, no correlation was observed between bendopnea and a profile indicating increased wedge pressure with normal cardiac index (P=.95).
Among those who underwent additional hemodynamic assessment, bendopnea was observed in 35% of participants. Median right arterial pressure was significantly higher in those with bendopnea when sitting (10 mm Hg vs. 4 mm Hg; P=.02), and was numerically higher when bending (19 mm Hg vs. 12 mm Hg; P=.07). Pulmonary capillary wedge pressure was significantly higher among those with bendopnea both when sitting and bending.
“Our study is the initial characterization of a novel symptom of HF, shortness of breath with bending forward, which we have termed bendopnea,” the researchers wrote. “ … [Bendopnea] is mediated via a further increase in ventricular filling pressures during bending in subjects whose sitting ventricular filling pressures are already high, particularly in patients with low [cardiac index]. Awareness of this symptom by physicians should improve their noninvasive assessment of hemodynamics in patients with HF.”
Disclosure: One researcher reported a financial relationship with Thoratec, and one reported receiving support from the James M. Wooten Chair in Cardiology.
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