Bendopnea Is Due To Elevated Left Ventricular Filling Pressures Rather Than Elevated Pulmonary Artery Pressures

Introduction Bendopnea, or dyspnea within 30 seconds of bending forward while not holding one's breath, is a recently described symptom of heart failure that has been associated with elevated pulmonary capillary wedge pressure (PCWP) and pulmonary artery pressures (PAP). Whether this symptom is due to elevation in PCWP or due to elevation in PAP has not previously been elucidated. Hypothesis The development of bendopnea is due to elevation in left-ventricular filling pressure, or PCWP, rather than elevation in PAP. Methods We prospectively enrolled a cohort of 209 patients who were undergoing right heart catheterization for clinically indicated purposes either for evaluation of heart failure with reduced ejection fraction (HFrEF, n=156) or non-World Health Organization class II pulmonary hypertension (PH, n=53). In this study, we analyzed data from the 83 patients with HFrEF who had a PCWP ≥ 16mmHg and the 52 patients with PH who had a mean PAP ≥ 20mmHg. A detailed clinical examination, including assessment of bendopnea, was conducted prior to the invasive hemodynamic assessment, and the cardiologist performing the catheterization was blinded to the physical examination findings. Logistic regression analysis tested the association of bendopnea with PCWP, mean PAP, and systolic PAP. Informed consent was obtained, and the Institutional Review Board approved the study protocol. Results Bendopnea was present in 37/135 (27%) subjects. Those with HFrEF versus PH were more likely to have bendopnea as well as an elevated PCWP, while there was no difference in the mean PAP between the groups (Figure). In univariable regression analysis, PCWP was associated with bendopnea (OR 1.1 [1.05, 1.15], p<0.001) but PASP was not (p=0.75). In models in which both PASP and PCWP were entered as covariates, PCWP (OR 1.1 [1.04, 1.15], p<0.001) remained associated with bendopnea but PASP (p=0.99) was not. Likewise, in a similar analysis with PCWP and MPA, PCWP was associated with bendopnea (OR 1.1 [1.04, 1.15], p=0.001), but MPA (p=0.44) was not. Conclusion Elevated left sided ventricular filling pressure, rather than pulmonary artery pressures, are the hemodynamic basis of bendopnea. Bendopnea, or dyspnea within 30 seconds of bending forward while not holding one's breath, is a recently described symptom of heart failure that has been associated with elevated pulmonary capillary wedge pressure (PCWP) and pulmonary artery pressures (PAP). Whether this symptom is due to elevation in PCWP or due to elevation in PAP has not previously been elucidated. The development of bendopnea is due to elevation in left-ventricular filling pressure, or PCWP, rather than elevation in PAP. We prospectively enrolled a cohort of 209 patients who were undergoing right heart catheterization for clinically indicated purposes either for evaluation of heart failure with reduced ejection fraction (HFrEF, n=156) or non-World Health Organization class II pulmonary hypertension (PH, n=53). In this study, we analyzed data from the 83 patients with HFrEF who had a PCWP ≥ 16mmHg and the 52 patients with PH who had a mean PAP ≥ 20mmHg. A detailed clinical examination, including assessment of bendopnea, was conducted prior to the invasive hemodynamic assessment, and the cardiologist performing the catheterization was blinded to the physical examination findings. Logistic regression analysis tested the association of bendopnea with PCWP, mean PAP, and systolic PAP. Informed consent was obtained, and the Institutional Review Board approved the study protocol. Bendopnea was present in 37/135 (27%) subjects. Those with HFrEF versus PH were more likely to have bendopnea as well as an elevated PCWP, while there was no difference in the mean PAP between the groups (Figure). In univariable regression analysis, PCWP was associated with bendopnea (OR 1.1 [1.05, 1.15], p<0.001) but PASP was not (p=0.75). In models in which both PASP and PCWP were entered as covariates, PCWP (OR 1.1 [1.04, 1.15], p<0.001) remained associated with bendopnea but PASP (p=0.99) was not. Likewise, in a similar analysis with PCWP and MPA, PCWP was associated with bendopnea (OR 1.1 [1.04, 1.15], p=0.001), but MPA (p=0.44) was not. Elevated left sided ventricular filling pressure, rather than pulmonary artery pressures, are the hemodynamic basis of bendopnea.