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Blacher M, Zimerman A, Engster PHB, Grespan E, Polanczyk CA, Rover MM, Neto JADF, Danzmann LC, Bertoldi EG, Simões MV, Beck-da-Silva L, Biolo A, Rohde LE. Revisiting heart failure assessment based on objective measures in NYHA functional classes I and II. Heart 2020; 107:1487-1492. [PMID: 33361353 DOI: 10.1136/heartjnl-2020-317984] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/11/2020] [Accepted: 11/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE New York Heart Association (NYHA) functional class plays a central role in heart failure (HF) assessment but might be unreliable in mild presentations. We compared objective measures of HF functional evaluation between patients classified as NYHA I and II in the Rede Brasileira de Estudos em Insuficiência Cardíaca (ReBIC)-1 Trial. METHODS The ReBIC-1 Trial included outpatients with stable HF with reduced ejection fraction. All patients had simultaneous protocol-defined assessment of NYHA class, 6 min walk test (6MWT), N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and patient's self-perception of dyspnoea using a Visual Analogue Scale (VAS, range 0-100). RESULTS Of 188 included patients with HF, 122 (65%) were classified as NYHA I and 66 (35%) as NYHA II at baseline. Although NYHA class I patients had lower dyspnoea VAS Scores (median 16 (IQR, 4-30) for class I vs 27.5 (11-49) for class II, p=0.001), overlap between classes was substantial (density overlap=60%). A similar profile was observed for NT-proBNP levels (620 pg/mL (248-1333) vs 778 (421-1737), p=0.015; overlap=78%) and for 6MWT distance (400 m (330-466) vs 351 m (286-408), p=0.028; overlap=64%). Among NYHA class I patients, 19%-34% had one marker of HF severity (VAS Score >30 points, 6MWT <300 m or NT-proBNP levels >1000 pg/mL) and 6%-10% had two of them. Temporal change in functional class was not accompanied by variation on dyspnoea VAS (p=0.14). CONCLUSIONS Most patients classified as NYHA classes I and II had similar self-perception of their limitation, objective physical capabilities and levels of natriuretic peptides. These results suggest the NYHA classification poorly discriminates patients with mild HF.
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Affiliation(s)
- Mariana Blacher
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - André Zimerman
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Pedro H B Engster
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Eduardo Grespan
- Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Carisi A Polanczyk
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Luiz C Danzmann
- Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil
| | | | | | - Luis Beck-da-Silva
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Andréia Biolo
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Luis E Rohde
- Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil .,Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.,Cardiovascular Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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