Cardiac Structure and Function and Pulmonary Congestion Across New York Heart Association Classes in Patients With...

Acute heart failure (AHF) is a major global health challenge, yet the relationship between New York Heart Association (NYHA) classification and objective markers such as echocardiography, lung ultrasound (LUS), and biomarkers remains unclear.

In this prospective two-center study, patients admitted with AHF (2022-2024) underwent echocardiography, 8-zone LUS, ECG, and biomarker sampling. Patients were stratified by NYHA class at enrollment, and associations with clinical, echocardiographic, and LUS measures were analyzed. Participants were invited for an identical follow-up examination 1-3 months post-discharge. The main outcome was a 180-day composite of AHF readmission or all-cause mortality evaluated across NYHA classes.

Among 564 patients (mean age 78.2 years; 56.3% male), 23% were classified as NYHA class I/II, 27% as NYHA class III, and 50% as NYHA class IV. Higher NYHA class at admission was associated with older age, greater comorbidity burden, lower left ventricular ejection fraction, impaired global longitudinal strain, higher E/e' ratio, and B-line count (all p <0.05). At follow-up (n = 160), left ventricular systolic function, B-line count, and left atrial size parameters were similar across baseline NYHA class. Atrial functional parameters (peak atrial longitudinal and contraction strain) remained lower with increasing NYHA class at admission (both p <0.05). NYHA class at admission was not associated with the 180-days outcome.

In this prospective study of hospitalized AHF patients, higher NYHA class at admission was associated with greater cardiac dysfunction, B-line burden, and comorbidity burden, but these differences largely resolved at follow-up. NYHA class at admission did not significantly predict the composite outcome.