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. 2022 Nov;24(11):2108-2117.
doi: 10.1002/ejhf.2651. Epub 2022 Aug 29.

Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure

Rafael de la Espriella  1 , Martina Amiguet  2 , Gema Miñana  1 , Juan Carlos Rodríguez  1 , Patricia Moyano  1 , Daniel Segarra  3 , Julio Fernández  4   5 , Enrique Santas  1 , Gonzalo Núñez  1 , Miguel Lorenzo  1 , Clara Bonanad  1 , Edgardo Alania  6 , Alfonso Valle  6 , Juan Sanchis  1   7   8 , Vicent Bodí  1   7   8 , Jose Luis Górriz  7   9 , Jorge Navarro  7 , Pau Codina  10 , Adriaan A Voors  11 , Antoni Bayés-Genís  8   10   12 , Julio Núñez  1   7   8
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Free article

Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure

Rafael de la Espriella et al. Eur J Heart Fail. 2022 Nov.
Free article

Abstract

Aims: Bendopnea is a clinical symptom of advanced heart failure with uncertain prognostic value. We aimed to evaluate whether bendopnea and the change in oxygen saturation when bending forward (bending oxygen saturation index [BOSI]) are associated with adverse outcomes in ambulatory chronic heart failure (CHF) patients.

Methods and results: We prospectively evaluated 440 subjects with symptomatic CHF. BOSI was defined as the difference between sitting and bending oxygen saturation (SpO2 ). The endpoint was the total number of worsening heart failure (WHF) events (heart failure hospitalization or urgent heart failure visit requiring parenteral diuretic therapy). The mean age was 74 ± 10 years, 257 (58.6%) were male, and 226 (51.4%) had a left ventricular ejection fraction <50%. Bendopnea was present in 94 (21.4%) patients, and 120 (27.3%) patients had a BOSI ≥-3%. The agreement between BOSI ≥-3% and bendopnea was moderate (Gwet's AC 0.482, p < 0.001). At a median (p25%-p75%) follow-up of 2.17 years (0.88-3.16), we registered 441 WHF events in 148 patients. After multivariable adjustment, BOSI was independently associated with the risk for total WHF episodes (overall, p < 0.001). Compared to improvement/no change in SpO2 when bending (BOSI 0%), those with BOSI ≥-3% showed an increased risk of WHF events (incidence rate ratio [IRR] 2.16, 95% confidence interval [CI] 1.67-2.79; p < 0.001). In contrast, bendopnea was not associated with the risk of total WHF episodes (IRR 1.04, 95% CI 0.83-1.31; p = 0.705).

Conclusions: In ambulatory and stable CHF patients, BOSI ≥-3% and not bendopnea was independently associated with an increased risk of total (first and recurrent) WHF episodes. Awareness of SpO2 while assessing bendopnea may be a useful tool for predicting heart failure decompensations.

Keywords: Arterial oxygen desaturation; Bendopnea; Outcome; Worsening heart failure.

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References

    1. Thibodeau JT, Turer AT, Gualano SK, Ayers CR, Velez-Martinez M, Mishkin JD, et al. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart Fail. 2014;2:24-31.
    1. Brandon N, Mehra MR. "Flexo-dyspnea": a novel clinical observation in the heart failure syndrome. J Heart Lung Transplant. 2013;32:844-5.
    1. Baeza-Trinidad R, Mosquera-Lozano JD, El Bikri L. Assessment of bendopnea impact on decompensated heart failure. Eur J Heart Fail. 2017;19:111-5.
    1. Dominguez-Rodriguez A, Thibodeau JT, Abreu-Gonzalez P, Ayers CR, Jimenez-Sosa A, Aranda JM, et al. Association between bendopnea and key parameters of cardiopulmonary exercise testing in patients with advanced heart failure. J Card Fail. 2016;22:163-5.
    1. Thibodeau JT, Jenny BE, Maduka JO, Divanji PH, Ayers CR, Araj F, et al. Bendopnea and risk of adverse clinical outcomes in ambulatory patients with systolic heart failure. Am Heart J. 2017;183:102-7.

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