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de la Espriella R, Amiguet M, Miñana G, Rodríguez JC, Moyano P, Segarra D, Fernández J, Santas E, Núñez G, Lorenzo M, Bonanad C, Alania E, Valle A, Sanchis J, Bodí V, Górriz JL, Navarro J, Codina P, Voors AA, Bayés-Genís A, Núñez J. Bending oxygen saturation index and risk of worsening heart failure events in chronic heart failure. Eur J Heart Fail 2022; 24:2108-2117. [PMID: 36054502 DOI: 10.1002/ejhf.2651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 01/18/2023] Open
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.
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Affiliation(s)
- Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Martina Amiguet
- Cardiology Department, Hospital General de Castellón, Castellón, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Juan Carlos Rodríguez
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Patricia Moyano
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Daniel Segarra
- Hospital Politécnico Universitario La Fe, Valencia, Spain
| | - Julio Fernández
- Gestión Sanitaria, Conselleria de Sanidad, Generalitat Valenciana, Valencia, Spain.,Departamento de Enfermería, Universidad de Valencia, Valencia, Spain
| | - Enrique Santas
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Gonzalo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Edgardo Alania
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Alicante, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Vicent Bodí
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
| | - Jose Luis Górriz
- Department of Medicine, Universitat de Valencia, Valencia, Spain.,Nephrology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Jorge Navarro
- Department of Medicine, Universitat de Valencia, Valencia, Spain
| | - Pau Codina
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Adriaan A Voors
- Department of Cardiology University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Antoni Bayés-Genís
- Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain.,Institut del Cor, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain.,Department of Medicine, Universitat de Valencia, Valencia, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovascular, Madrid, Spain
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