title: Bendopnea and risk of adverse clinical outcomes in ambulatory patients with systolic heart failure.
abstract: BACKGROUND
  Recently, the symptom of bendopnea, that is, shortness of breath when bending forwards such as when putting on shoes, has been described in heart failure patients and found to be associated with higher ventricular filling pressures, particularly in the setting of low cardiac index. However, it is not known whether bendopnea is associated with clinical outcomes.
  
  
  METHODS
  In a prospective convenience sample of 179 patients followed in our heart failure disease management clinic, we determined the presence of bendopnea at the time of enrollment and ascertained clinical outcomes through 1 year of follow-up. We performed univariate and stepwise multivariable modeling to test the association of bendopnea with clinical outcomes.
  
  
  RESULTS
  Bendopnea was present in 32 of 179 (18%) subjects. At 1 year, those with versus without bendopnea were at increased risk of the composite endpoint of death, heart failure admission, inotrope initiation, left ventricular assist device implantation, or cardiac transplantation in univariate (hazard ratio [HR] 1.9, P < .05) but not multivariable (HR 1.9, P = .11) analysis. Bendopnea was more strongly associated with short-term outcomes including heart failure admission at 3 months in both univariate (HR 3.1, P < .004) and multivariable (HR 2.5, P = .04) analysis.
  
  
  CONCLUSIONS
  Bendopnea was associated with an increased risk of adverse outcomes in ambulatory patients with heart failure, particularly heart failure admission at 3 months.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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, TX.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Jenny
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Jeomi O
authors.initials: JO
authors.lastname: Maduka
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Punag H
authors.initials: PH
authors.lastname: Divanji
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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, TX.
authors.forename: Faris
authors.initials: F
authors.lastname: Araj
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Amin
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Morlend
authors.affiliation: Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
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, TX. Electronic address: Mark.Drazner@utsouthwestern.edu.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Drazner
mesh_terms: D000368:Aged; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D054143:Heart Failure, Systolic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk