title: Characterization of a novel symptom of advanced heart failure: bendopnea.
abstract: OBJECTIVE
  This study sought to examine the frequency and hemodynamic correlates of shortness of breath when bending forward, a symptom we have termed "bendopnea."
  
  
  BACKGROUND
  Many heart failure patients describe bendopnea such as when putting on their shoes. This symptom has not previously been characterized.
  
  
  METHODS
  We conducted a prospective study of 102 subjects with systolic heart failure referred for right-heart catheterization. Time to onset of bendopnea was measured prior to catheterization. Forty-six subjects also underwent hemodynamic assessment when sitting and bending. Hemodynamic profiles were assigned on the basis of whether pulmonary capillary wedge pressure (PCWP) was ≥ 22 mm Hg and cardiac index (CI) was ≤ 2.2 l/min/m(2).
  
  
  RESULTS
  Bendopnea was present in 29 of 102 (28%) subjects with median (25th, 75th percentiles) time to onset of 8 (7, 11) seconds. Subjects with bendopnea had higher supine right atrial pressure (RAP) (p = 0.001) and PCWP (p = 0.0004) than those without bendopnea but similar CI (p = 0.2). RAP and PCWP increased comparably in subjects with and without bendopnea when bending, but CI did not change. In those with, versus without, bendopnea, there was more than a 3-fold higher frequency of a supine hemodynamic profile consisting of elevated PCWP with low CI (55% vs. 16%, respectively, p < 0.001) but no association with a profile of elevated PCWP with normal CI (p = 0.95).
  
  
  CONCLUSIONS
  Bendopnea is mediated via a further increase in filling pressures during bending when filling pressures are already high, particularly if CI is reduced. Awareness of bendopnea should improve noninvasive assessment of hemodynamics in subjects with heart failure.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Thibodeau
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Aslan T
authors.initials: AT
authors.lastname: Turer
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Gualano
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Colby R
authors.initials: CR
authors.lastname: Ayers
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Mariella
authors.initials: M
authors.lastname: Velez-Martinez
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Mishkin
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Parag C
authors.initials: PC
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Pradeep P A
authors.initials: PP
authors.lastname: Mammen
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: David W
authors.initials: DW
authors.lastname: Markham
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Levine
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: mark.drazner@utsouthwestern.edu.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Drazner
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*; D011446:Prospective Studies; D016683:Supine Position / Q000502:physiology
keywords: dyspnea; heart failure; hemodynamics