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.