The relationship between functional class and cardiac performance in patients with chronic aortic insufficiency

We have evaluated the relationship of New York Heart Association functional class (FC) assessment to rest and exercise hemodynamics and resting left ventricular (LV) functional data in 75 consecutive patients with isolated, chronic aortic insufficiency. Although there was a tendency for hemodynamic and angiographic variables to worsen as FC increased there was considerable overlap between patients assigned to the various groups. Statistically significant differences were seen only for resting left ventricular end-diastolic pressure (LVEDP) and pulmonary artery wedge (PAW) pressure which were higher in FC 3/4 patients than in FC 1 or 2 patients. The results of our study suggest that FC assignment cannot be used to accurately define underlying LV performance or hemodynamics in an individual patient with chronic aortic insufficiency. However, since severe abnormalities are unlikely to be present in asymptomatic patients, routine detailed frequent investigation does not seem warranted in this group. As FC worsens, the likelihood of left ventricular dysfunction increases. Thus, the presence of symptoms is an indication for more extensive evaluation.