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[Comparison of NYHA classification with cardiopulmonary function in patients with chronic heart failure]
1II. Medizinische Klinik und Poliklinik, Johannes-Gutenberg-Universität Mainz.
Insights
Cardiopulmonary exercise testing (CPX) correlates with heart failure prognosis. Oxygen consumption at the anaerobic threshold (VO2-AT) aligns with NYHA class, offering valuable disease progression insights beyond ejection fraction.
Area of Science:
- Cardiology
- Pulmonology
- Exercise Physiology
Background:
- Heart failure (HF) management relies on assessing disease severity and prognosis.
- New York Heart Association (NYHA) classification and ejection fraction (EF) are common metrics.
- Cardiopulmonary exercise testing (CPX) offers objective functional capacity assessment.
Purpose of the Study:
- To investigate the correlation between NYHA functional class, CPX parameters (VO2-max, VO2-AT), and EF in heart failure patients.
- To determine the prognostic value of these measures.
Main Methods:
- 36 heart failure patients (20 CAD, 16 DCM) and 23 controls underwent CPX.
- NYHA class was assessed by blinded cardiologists.
- CPX measured VO2-max and VO2-AT using a ramp protocol.
Main Results:
- A significant correlation was found between NYHA class and VO2-AT (p=0.0425).
- VO2-AT was significantly higher in NYHA class II vs. III patients.
- VO2-AT and VO2-max were significantly lower in HF patients compared to controls.
- No significant correlation was observed between EF and NYHA class or CPX parameters.
- Lethality was high (8/14) in patients with VO2-AT < 10 ml/kg/min.
Conclusions:
- NYHA classification is a valid prognostic tool for heart failure.
- CPX, particularly VO2-AT, provides objective data that correlates with NYHA class and can offer valuable updates on disease progression.
- EF did not correlate with functional capacity or NYHA class in this cohort.
Abstract:
In this study a correlation was sought between the NYHA class, the results of cardiopulmonary exercise testing (CPX) and the ejection fraction (EF) measured by echocardiography and scintigraphy. Of 36 patients enrolled, CHF in 20 patients was due to CAD and in 16 patients due to DCM. The NYHA class was determined independently by two cardiologists who were blinded to the CPX, echocardiography or scintigraphy results. Sixteen patients were classified as class II and 20 as class III. As a control, 23 patients without cardiopulmonary disease were examined. The CPX was done according to a ramp protocol with continuous measurement of respiratory gases, maximal oxygen consumption (VO2-max) and oxygen consumption at the anaerobic threshold (VO2-AT). A correlation (p = 0.0425) between the NYHA classification and the Weber classification for VO2-AT was found. There was no correlation for VO2-max. VO2-AT was significantly higher in NYHA II patients as compared to NYHA III patients. No significant difference was seen in relation to the VO2-max. In comparison to the normal group, the VO2-AT and VO2-max were significantly lower in NYHA II and III patients. There was no significant correlation between VO2-AT and EF, VO2-max and EF, or between NYHA class and EF. During a 16-month follow-up period lethality was 8/14 patients with VO2-AT < 10 ml/kg/min. Although the NYHA classification provides a valid method for determining the prognosis of CHF patients, if feasible, the CPX examinations should be used to provide updates of the disease progress.