Tag Archives: JACC

The unheard-of symptom – Bendopnea

Characterization of a Novel Symptom of Advanced Heart Failure: Bendopnea

JCHF. 2014;2(1):24-31. doi:10.1016/j.jchf.2013.07.009

Objectives:  This study sought to examine the frequency and hemodynamic correlates of shortness of breath when bending forward, a symptom that has been named by the newly coined term “bendopnea.”

Background:  Many heart failure patients describe bendopnea such as when putting on their shoes. This symptom has not previously been characterized.

Methods: This was a prospective study of 102 subjects with systolic heart failure referred for right-heart catheterization. Time to onset of bendopnea was measured prior to catheterization. Forty-six subjects also underwent hemodynamic assessment when sitting and bending. Hemodynamic profiles were assigned on the basis of whether pulmonary capillary wedge pressure (PCWP) was ≥22 mm Hg and cardiac index (CI) was ≤2.2 l/min/m2.

Results: Bendopnea was present in 29 of 102 (28%) subjects with median (25th, 75th percentiles) time to onset of 8 (7, 11) seconds. Subjects with bendopnea had higher supine right atrial pressure (RAP) (p = 0.001) and PCWP (p = 0.0004) than those without bendopnea but similar CI (p = 0.2). RAP and PCWP increased comparably in subjects with and without bendopnea when bending, but CI did not change. In those with, versus without, bendopnea, there was more than a 3-fold higher frequency of a supine hemodynamic profile consisting of elevated PCWP with low CI (55% vs. 16%, respectively, p < 0.001) but no association with a profile of elevated PCWP with normal CI (p = 0.95).

Conclusions: Bendopnea is mediated via a further increase in filling pressures during bending when filling pressures are already high, particularly if CI is reduced. Awareness of bendopnea should improve noninvasive assessment of hemodynamics in subjects with heart failure.

MI rates with Ticagrelor (from PLATO)

This article in JACC examines the rates of MI in patients with ACS treated with ticagrelor vs clopidogrel.

The rates of overall MI at 12 months:

1. Ticagrelor- 5.8%

2. Clopidogrel – 6.9%

3. Nonprocedural MI (HR: 0.86; 95% CI: 0.74 to 1.01) and MI related to percutaneous      coronary intervention or stent thrombosis tended to be lower with ticagrelor.

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Colchicine in Stable Chronic Heart Failure

Heart failure is associated with activation of inflammatory cascades. this trial examines the effects of usig colchicine in Hf.

American College of Cardiology Foundation | JACC: Heart Failure | Anti-Inflammatory Treatment With Colchicine in Stable Chronic Heart FailureA Prospective, Randomized Study.

Natural history of pediatric idiopathic DCM

Natural history studies of pediatric idiopathic dcm are scarce. previous studies have demonstrated heterogenous figures of actuarial survival at 1 year of 63-90%, and at 5 years of 20-80%. this study add to our knowledge of natural history and LV function recovery.

American College of Cardiology Foundation | Journal of the American College of Cardiology | Recovery of Echocardiographic Function in Children With Idiopathic Dilated CardiomyopathyResults From the Pediatric Cardiomyopathy Registry.

REOPEN-AMI Trial

high-dose intracoronary adenosine after thrombus aspiration improves microvascular dysfunction, LV remodelling.

American College of Cardiology Foundation | Journal of the American College of Cardiology | Left Ventricular Remodeling and 1-Year Clinical Follow-Up of the REOPEN-AMI Trial.