Bendopnoea in patients at high risk of heart failure: prevalence and association with markers of cardiac function and congestion
A Alsaeed, H Khin, D Hunter, K Martin, N Greenlaw, M Morsy, P Maffia, J G F Cleland, P PellicoriAbstract
Background
Bendopnoea refers to the sensation of shortness of breath when bending down, for instance to tie shoe-laces. In patients with heart failure, it has been proposed to indicate elevated cardiac filling pressures. However, its associations with markers of cardiac function and congestion in individuals without overt heart failure have not been studied.
Purpose
To determine the prevalence of bendopnoea and its association with markers of cardiac function and congestion in patients at high risk of heart failure.
Methods
This was a single-centre, prospective observational cohort study of adults (≥18 years) with ≥1 heart failure risk factor (hypertension, type 2 diabetes mellitus, ischaemic heart disease, chronic kidney or pulmonary disease, atrial fibrillation, raised natriuretic peptides, or loop diuretic use) invited from primary care. After signing a consent form, participants underwent clinical assessment, echocardiography, and congestion ultrasound. Congestion was defined a priori by the presence of a dilated inferior vena cava (IVC, >20 mm), jugular venous distensibility (JVD) ratio <4 (the ratio of the jugular vein diameter during Valsalva to that at rest), or ≥15 B-lines on a 28-zone lung ultrasound. Bendopnoea was assessed using a structured symptom questionnaire.
Results
501 participants were recruited into this study, median age of 68 years, 62% men. Bendopnoea was reported by 158 participants (31.5%). Compared to others, participants with bendopnoea had higher body mass index (31.3 [27.6–35.9] vs 28.7 [25.6–32.9] kg/m², p<0.0001), were more likely to be in NYHA functional class >I (32% vs 10%, p<0.0001), and were more likely to have chronic lung disease (21% vs 8%, p=0.0001), peripheral oedema (48.1% vs 39.4%, p=0.019) and orthopnoea (16.5% vs 2.9%, p<0.0001). In contrast, age (69 vs 68 years), NT-proBNP (139ng/L vs 145.0 ng/L), cardiac function on echocardiography or markers of congestion on ultrasound were not statistically different between those with and without bendopnoea (p>0.05).
Conclusion
In patients at high risk of heart failure, bendopnoea is common and associates with obesity, respiratory comorbidity, and greater symptom burden, but not with objective evidence of cardiac dysfunction.