Bendopnea May Signal Heart Failure Progression

Experiencing shortness of breath while bending over may reveal more than just low fitness level; it may be a symptom of advancing heart failure.

A team of cardiologists at UT Southwestern Medical Center, who defined the symptom of shortness of breath while bending over as bendopnea, conducted a prospective study of 102 patients with systolic heart failure who were referred for right-heart catheterization. All patients were assessed for time to onset of bendopnea prior to catheterization, and 46 of these patients additionally underwent hemodynamic assessment for sitting and bending. Hemodynamic profiles were assigned on the basis of whether pulmonary capillary wedge pressure (PCWP) was >22 mm Hg and if cardiac index was <2.2 L/min/m².
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PCWP is considered the gold standard for determining the cause of acute pulmonary edema, which may be present at a PCWP value of >20 mm Hg. The cardiac index is a useful marker relating to cardiac output. A normal range for cardiac index at rest is approximately 2.6 to 4.2 L/min/m².

Bendopnea was present in 28% of patients with median time to onset of 8 seconds. These patients tended to have higher supine right atrial pressure (P=.001) and PCWP (P=.0004) than patients without bendopnea, but both groups had similar cardiac indices.

“We discovered that patients with bendopnea had too much fluid in their bodies, causing elevated pressures, and when they bent forward, these pressures increased even more,” said lead author Jennifer Thibodeau, assistant professor of internal medicine at UT Southwestern’s cardiology division, in a press release.

Patients with bendopnea compared with patients without bendopnea had a 3-fold higher frequency of a supine hemodynamic profile consisting of elevated PCWP with low cardiac index (55% vs 16%, respectively, P<.001), but there was no association with a profile of elevated PCWP with normal cardiac index (P=.95).

Dr. Thibodeau advised that bendopnea is not a risk factor for heart failure, but rather a symptom that heart failure may be worsening, and that clinicians should consider adjusting treatment accordingly.

-Allison Musante, ELS

Reference

Thibodeau JT, Turer AT, Gualano SK, et al. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart Fail. 2014;2(1):24-31.