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Bendopnea: A new symptom for the differential diagnosis of chronic cardiopulmonary disease?
Flexopneia: um novo sintoma a utilizar no diagnóstico diferencial de patologias crónicas cardiopulmonares?
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "187" "paginaFinal" => "188" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Ana Teresa Timóteo" "autores" => array:1 [ 0 => array:4 [ "nombre" => "Ana Teresa" "apellidos" => "Timóteo" "email" => array:1 [ 0 => "ana_timoteo@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Cardiologia, Hospital Santa Marta, Centro Hospitalar Lisboa Central, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "NOVA Medical School, Lisboa, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Flexopneia: um novo sintoma a utilizar no diagnóstico diferencial de patologias crónicas cardiopulmonares?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Bendopnea is a symptom of heart failure (HF) recently described by Thibodeau et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> characterized by difficulty in breathing when leaning over. It frequently occurs when performing everyday actions such as tying shoelaces or putting on socks.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Dyspnea in its various forms (exertional dyspnea, orthopnea and paroxysmal nocturnal dyspnea) is a major and extremely common symptom in HF. Exertional dyspnea is also found in other conditions, particularly respiratory disease, and is thus a moderately sensitive but relatively nonspecific marker of HF. Orthopnea is more directly associated with increased filling pressures and is thus much more specific.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a> In their original description of bendopnea, published in 2014, Thibodeau et al. analyzed the frequency of this symptom in patients with HF with left ventricular systolic dysfunction (HF with reduced ejection fraction [HFrEF]) referred for cardiac catheterization.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> The investigation of bendopnea in this study was based on an objective assessment, in which the patient adopted the appropriate position in the presence of an investigator, and the symptom was identified in 28% of individuals.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Pathophysiologically, the condition appears to be linked to positional increase in left and right ventricular filling pressures in patients whose baseline pressures are already elevated<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> (although it is not clear whether intrathoracic or intra-abdominal pressures are involved), and generally appears within 30 s of bending over. It is even more common (48.8%) in patients with decompensated HF, with either reduced or preserved ejection fraction.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> Some authors consider that it may be a valuable marker for early identification of decompensated HF.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> It also appears to be related to short-term mortality.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> In functional studies using cardiopulmonary exercise testing, bendopnea was associated with elevated VE/VCO<span class="elsevierStyleInf">2</span>.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In their study published in this issue of the <span class="elsevierStyleItalic">Journal</span>, Martinez Cerón et al. analyze the association between different forms of dyspnea and chronic non-communicable diseases, particularly cardiopulmonary disease, in primary health care.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> The study included 633 randomly selected individuals aged 45-99 years who completed a questionnaire and underwent clinical assessment, laboratory testing, electrocardiography and echocardiography. The authors concluded that bendopnea was the only form of dyspnea not associated with chronic obstructive pulmonary disease (COPD), but that it was associated with HF, particularly HF with preserved ejection fraction (HFpEF). Interestingly, they also reported significant associations with depression and diabetes, a finding that merits more detailed investigation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">However, the study has certain limitations that should be borne in mind. Firstly, the questionnaire is highly subjective and does not allow for an objective analysis of the symptoms analyzed. For example, difficulty in bending over could be due to musculoskeletal or other problems rather than to dyspnea. The attribution of diagnoses of comorbidities is also inadequate: the presence of COPD is determined only by clinical history and not confirmed by diagnostic tests, and HF was also defined very broadly, without differentiating between left and right HF, and HFpEF was diagnosed solely on the basis of systolic function, without reference to biomarkers such as B-type natriuretic peptide, which are essential to this diagnosis. Other diagnoses also lacked precision, particularly of diabetes, for which a single fasting blood glucose measurement is insufficient without other assessments, particularly determination of HbA1c. In terms of the statistical analysis, another important limitation relates to the sample size. While the overall population size is significant, the subgroups analyzed are small: only 22 participants presented COPD, 35 HFpEF and 29 HFrEF. Statistical analysis, particularly multivariate analysis, on such small samples is unlikely to be conclusive. This may be why the study found no association between bendopnea and HFrEF, unlike previous publications, and the link with diabetes may have been due to chance. Indeed, all the associations – or lack of them – reported in the study should be viewed with considerable caution.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The work has the merit of attempting to address the question of the symptomatology of chronic diseases in a primary health care setting. It also aims to correlate the occurrence of dyspnea, a common symptom in HF, with its occurrence in other conditions. Bendopnea is without doubt a valuable symptom, as shown by the results of Thibodeau et al. However, more detailed analysis of its specificity is required, a task that Martinez Cerón et al. attempt, but only in a limited fashion. Further studies will be needed with larger populations (and hence greater statistical power) of patients with HFpEF, HFrEF and especially COPD and other respiratory diseases, as well as with a control group, using precise definitions that will enable accurate assessment of the different diagnoses under consideration, and a detailed analysis of the specificity and sensitivity of this new and promising symptom.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Timóteo AT. Flexopneia: um novo sintoma a utilizar no diagnóstico diferencial de patologias crónicas cardiopulmonares? Rev Port Cardiol. 2017;36:187–188.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization of a novel symptom of advanced heart failure: bendopneia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.T. Thibodeau" 1 => "A.T. Turer" 2 => "S.K. Gualano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Am Coll Cardiol HF" "fecha" => "2014" "volumen" => "2" "paginaInicial" => "24" "paginaFinal" => "31" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "(epub ahead of print)" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of bendopnea impact on decompensated heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Baeza-Trinidad" 1 => "J.D. Mosquera-Lozano" 2 => "L. El Bikri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Eur J Heart Fail" "fecha" => "2016" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization of a novel symptom of advanced heart failure: bendopnea" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "N. Brandon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2014" "volumen" => "2" "paginaInicial" => "540" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association between bendopnea and key parameters of cardiopulmonary exercise testing in patients with advanced heart failure" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Dominguez-Rodriguez" 1 => "J.T. Thibodeau" 2 => "P. Abreu-Gonzalez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cardfail.2015.12.013" "Revista" => array:6 [ "tituloSerie" => "J Card Fail" "fecha" => "2016" "volumen" => "22" "paginaInicial" => "163" "paginaFinal" => "165" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26708354" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Associação dos tipos de dispneia e da “flexopneia” com as patologias cardiopulmonares na atenção primária" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.M. Martinez Cerón" 1 => "M.L. Garcia Rosa" 2 => "A.J. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 34 | 5 | 39 |
| 2024 October | 183 | 33 | 216 |
| 2024 September | 175 | 32 | 207 |
| 2024 August | 186 | 35 | 221 |
| 2024 July | 136 | 35 | 171 |
| 2024 June | 204 | 32 | 236 |
| 2024 May | 162 | 46 | 208 |
| 2024 April | 119 | 34 | 153 |
| 2024 March | 101 | 30 | 131 |
| 2024 February | 87 | 36 | 123 |
| 2024 January | 101 | 25 | 126 |
| 2023 December | 89 | 30 | 119 |
| 2023 November | 118 | 32 | 150 |
| 2023 October | 90 | 27 | 117 |
| 2023 September | 95 | 15 | 110 |
| 2023 August | 165 | 11 | 176 |
| 2023 July | 153 | 10 | 163 |
| 2023 June | 136 | 12 | 148 |
| 2023 May | 202 | 24 | 226 |
| 2023 April | 208 | 11 | 219 |
| 2023 March | 259 | 35 | 294 |
| 2023 February | 163 | 19 | 182 |
| 2023 January | 128 | 20 | 148 |
| 2022 December | 111 | 23 | 134 |
| 2022 November | 201 | 26 | 227 |
| 2022 October | 141 | 28 | 169 |
| 2022 September | 128 | 42 | 170 |
| 2022 August | 144 | 39 | 183 |
| 2022 July | 126 | 31 | 157 |
| 2022 June | 152 | 22 | 174 |
| 2022 May | 159 | 38 | 197 |
| 2022 April | 132 | 44 | 176 |
| 2022 March | 130 | 29 | 159 |
| 2022 February | 135 | 44 | 179 |
| 2022 January | 170 | 37 | 207 |
| 2021 December | 145 | 44 | 189 |
| 2021 November | 157 | 47 | 204 |
| 2021 October | 216 | 68 | 284 |
| 2021 September | 179 | 57 | 236 |
| 2021 August | 163 | 44 | 207 |
| 2021 July | 137 | 33 | 170 |
| 2021 June | 136 | 29 | 165 |
| 2021 May | 159 | 51 | 210 |
| 2021 April | 343 | 56 | 399 |
| 2021 March | 283 | 29 | 312 |
| 2021 February | 290 | 36 | 326 |
| 2021 January | 140 | 21 | 161 |
| 2020 December | 130 | 19 | 149 |
| 2020 November | 148 | 29 | 177 |
| 2020 October | 135 | 24 | 159 |
| 2020 September | 159 | 20 | 179 |
| 2020 August | 133 | 21 | 154 |
| 2020 July | 202 | 14 | 216 |
| 2020 June | 160 | 23 | 183 |
| 2020 May | 188 | 18 | 206 |
| 2020 April | 159 | 24 | 183 |
| 2020 March | 194 | 18 | 212 |
| 2020 February | 238 | 94 | 332 |
| 2020 January | 147 | 24 | 171 |
| 2019 December | 127 | 8 | 135 |
| 2019 November | 91 | 21 | 112 |
| 2019 October | 115 | 13 | 128 |
| 2019 September | 152 | 30 | 182 |
| 2019 August | 91 | 14 | 105 |
| 2019 July | 79 | 21 | 100 |
| 2019 June | 74 | 34 | 108 |
| 2019 May | 115 | 23 | 138 |
| 2019 April | 95 | 30 | 125 |
| 2019 March | 124 | 26 | 150 |
| 2019 February | 121 | 21 | 142 |
| 2019 January | 120 | 18 | 138 |
| 2018 December | 121 | 13 | 134 |
| 2018 November | 134 | 9 | 143 |
| 2018 October | 241 | 23 | 264 |
| 2018 September | 67 | 15 | 82 |
| 2018 August | 59 | 7 | 66 |
| 2018 July | 56 | 4 | 60 |
| 2018 June | 87 | 13 | 100 |
| 2018 May | 111 | 9 | 120 |
| 2018 April | 81 | 13 | 94 |
| 2018 March | 142 | 15 | 157 |
| 2018 February | 61 | 8 | 69 |
| 2018 January | 98 | 10 | 108 |
| 2017 December | 102 | 7 | 109 |
| 2017 November | 60 | 10 | 70 |
| 2017 October | 38 | 20 | 58 |
| 2017 September | 47 | 19 | 66 |
| 2017 August | 43 | 19 | 62 |
| 2017 July | 41 | 25 | 66 |
| 2017 June | 50 | 18 | 68 |
| 2017 May | 69 | 19 | 88 |
| 2017 April | 72 | 21 | 93 |
| 2017 March | 54 | 17 | 71 |
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