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Research Article: Bendopnea as an independent prognostic marker for adverse events in hospitalized heart failure patients: insights from a multicenter prospective cohort study

Date Published: 2025-09-24

Abstract:
Heart failure (HF) remains a leading cause of cardiovascular morbidity and mortality globally, affecting over 64 million individuals ( 1 ). Despite advancements in therapeutic strategies, the heterogeneity of HF symptoms complicates risk stratification and personalized management. Bendopnea, defined as dyspnea occurring within 30?s of forward trunk flexion, has emerged as a potential marker of hemodynamic compromise, yet its clinical significance in large multicenter cohorts remains underexplored. This prospective study enrolled 482 hospitalized HF patients from 2 tertiary care centers, stratifying them into bendopnea ( n =?208) and non-bendopnea ( n =?274) groups. Our results demonstrated that bendopnea was associated with more severe cardiac dysfunction, including lower left ventricular ejection fraction (LVEF: 38.9%?±?7.6% vs. 42.7%?±?8.1%, P <?0.001), larger left ventricular end-diastolic diameter (LVEDD: 63.8?±?5.9?mm vs. 59.2?±?5.6?mm, P <?0.001), and higher NT-proBNP levels (median 1,320.5?ng/L vs. 985.2?ng/L, P <?0.001). Over 1.5 years of follow-up, patients with bendopnea exhibited a significantly higher cumulative incidence of adverse events: HF rehospitalization (35.1% vs. 22.3%, P <?0.001), all-cause mortality (19.7% vs. 12.4%, P =?0.003), and arrhythmias requiring intervention (20.7% vs. 11.7%, P =?0.001). Multivariable Cox regression confirmed bendopnea as an independent predictor of adverse outcomes ( HR =?1.6, 95% CI 1.3–2.0, P <?0.001). These findings highlight bendopnea as a clinically actionable marker for risk stratification in HF, supporting its integration into routine clinical practice.

Introduction:
Heart failure (HF) is a progressive syndrome characterized by impaired cardiac function, leading to systemic hypoperfusion and fluid retention ( 2 ). With a 5-year mortality rate exceeding 50% in severe cases, HF imposes a substantial burden on healthcare systems worldwide ( 3 ). The clinical presentation of HF is heterogeneous, with typical symptoms such as exertional dyspnea and orthopnea often overlapping with other conditions, complicating timely diagnosis and risk assessment ( 4 ). In recent years, atypical…

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