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Routine serial echocardiography in systolic heart failure: is it time for the heart failure guidelines to change?

Kathy Hebert1, Francisco Yuri Bulcao Macedo, Patrick Trahan

  • 1Department of Medicine, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136, USA. khebert1@gmail.com

Congestive Heart Failure (Greenwich, Conn.)
|April 1, 2011
PubMed

Insights

Clinician-assessed symptoms via New York Heart Association (NYHA) classification are unreliable for tracking systolic heart failure (HF) progression. Echocardiography-measured ejection fraction (EF) provides more accurate prognostic data for guiding HF therapy.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Medical Diagnostics

Background:

  • Systolic heart failure (HF) management relies on accurate patient status assessment.
  • Serial echocardiography is considered for routine use in HF guidelines.
  • The reliability of clinician-assessed symptoms (NYHA class) versus objective measures needs evaluation.

Purpose of the Study:

  • To compare the reliability of New York Heart Association (NYHA) functional classification with echocardiography-measured ejection fraction (EF) in assessing systolic heart failure (HF) prognosis.
  • To provide objective evidence for informing American College of Cardiology Heart Failure Guidelines regarding serial echocardiography.

Main Methods:

  • Prospective study involving 256 patients with systolic HF (EF ≤40%) in an HF disease management program.
  • Patients underwent at least two annual echocardiograms.
  • Clinician-assessed NYHA functional classification was compared with EF changes measured by echocardiography.

Main Results:

  • Only 33.5% of patients were correctly classified by NYHA class compared to echocardiographic findings.
  • Patients with no change in NYHA class between echocardiograms exhibited the lowest survival rates.
  • NYHA classification showed significant discordance with objective echocardiographic data.

Conclusions:

  • New York Heart Association (NYHA) functional classification is not always a reliable tool for assessing prognosis in systolic heart failure (HF).
  • Objective measures like ejection fraction (EF) from echocardiography are crucial for evaluating patient status and guiding medical therapy in HF.
  • Findings support the need for objective assessments in HF management and guideline development.

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