Risk Assessment of Development of the Major Adverse Cardiac Events in Patients with Chronic Heart Failure with a Preserved and Intermediate Ejection Fraction in the Presence of a Bendopnea Symptom

Aim To evaluate the risk of major cardiovascular complications (CVC) in patients with chronic heart failure (CHF) with intermediate and preserved ejection fraction (EF) depending on the presence of bendopnea symptom.
Material and methods The study included 104 patients with stage II CHF and left ventricular EF ≥40 %. Mean age of the patients was 72.8±10.6 years. A test for detection of bendopnea symptom was performed for all patients. Two groups were formed: group 1, 69 patients with the bendopnea symptom and group 2, 35 patients with a negative test. Follow-up duration was 24 months. The composite endpoint (CEP) was death and hospitalization for any CVC.
Results Mean time to the bendopnea symptom was 17.3±6.61 s. At two years of follow-up, the CEP was observed in 36 (34.6 %) patients, including 30 (43.5 %) patients in group 1 and 6 (17.1 %) patients in group 2. 12 patients died, and 9 of them had the bendopnea symptom. 21 patients of group 1 were hospitalized for CVC. Risk of CEP was significantly 1.7 times higher for men (relative risk, RR 1.7 [1.1; 2.6]) than for women. The presence of bendopnea symptom increased the risk of CEP 1.4 times (ОР 1.4 [1.1;1.9]) for women and 2.3 times (RR 2.3 [1.4; 3.6]) for men.
Conclusion Results of the study demonstrated an unfavorable effect of bendopnea symptom on risk of CEP during the two-year follow-up of CHF patients with preserved and intermediate EF.

1. Ponikowski P. et al. Heart failure: preventing disease and death worldwide: Addressing heart failure // ESC Heart Fail. 2014. Vol. 1, № 1. P. 4–25.DOI: http://doi.wiley.com/10.1002/ehf2.12005

2. Thibodeau J.T. et al. Characterization of a Novel Symptom of Advanced Heart Failure: Bendopnea // JACC Heart Fail. 2014. Vol. 2, № 1. P. 24–31. DOI: 10.1016/j.jchf.2013.07.009

3. Kip K.E. et al. The Problem With Composite End Points in Cardiovascular Studies: The Story of Major Adverse Cardiac Events and Percutaneous Coronary Intervention // J. Am. Coll. Cardiol. 2008. Vol. 51, № 7. P. 701–707. DOI: 10.1016/j.jacc.2007.10.034

4. Pranata R. et al. Clinical significance of bendopnea in heart failure—Systematic review and meta-analysis // Indian Heart J. 2019. Vol. 71, № 3. P. 277–283. DOI: 10.1016/j.ihj.2019.05.001

5. Thibodeau J.T. et al. Bendopnea and risk of adverse clinical outcomes in ambulatory patients with systolic heart failure // Am. Heart J. 2017. Vol. 183. P. 102–107. DOI: 10.1016/j.ahj.2016.09.011

6. Baeza‐Trinidad R., Mosquera‐Lozano J.D., Bikri L.E. Assessment of bendopnea impact on decompensated heart failure // Eur. J. Heart Fail. 2017. Vol. 19, № 1. P. 111–115. DOI: 10.1002/ejhf.610

7. Dominguez-Rodriguez A. et al. Association Between Bendopnea and Key Parameters of Cardiopulmonary Exercise Testing in Patients With Advanced Heart Failure // J. Card. Fail. 2016. Vol. 22, № 2. P. 163–165. DOI: 10.1016/j.cardfail.2015.12.013

8. Dragunov D.O. et al. [Quality of life in patients with heart failure with preserved ejection fraction and the bendopnea symptom] // Kardiologiia. 2019. Vol. 59, № 6S. P. 24–32. DOI: 10.18087/cardio.2507

9. Larina V.N. et al. Clinical and prognostic significance of bendopnea in elderly outpatients // Cardiovasc. Ther. Prev. 2019. Vol. 18, № 6. P. 45–50. DOI: 10.15829/1728-8800-2019-6-45-50

10. Sajeev C.G. et al. Demographical and clinicopathological characteristics in heart failure and outcome predictors: a prospective, observational study // ESC Heart Fail. 2016. Vol. 4, № 1. P. 16–22. DOI: 10.1002/ehf2.12119

11. Baeza-Trinidad R. et al. Evolution of bendopnea during admission in patients with decompensated heart failure // Eur. J. Intern. Med. 2018. Vol. 51. P. e23–e24. DOI: 10.1016/j.ejim.2018.02.026