NYHA Classification and Cardiopulmonary Exercise Test Variables in Patients with Heart Failure

Keywords
Heart Failure; Hospitalization; Mortality; Oxygen Consumption; Exercise Test; Walk Test; Physical Activity; Life Style

Palavras-chave
Insuficiência Cardíaca; Hospitalização; Mortalidade; Consumo de Oxigênio; Teste de Esforço; Teste de Caminhada; Atividade Física; Estilo de Vida

Keywords
Heart Failure; Hospitalization; Mortality; Oxygen Consumption; Exercise Test; Walk Test; Physical Activity; Life Style

Palavras-chave
Insuficiência Cardíaca; Hospitalização; Mortalidade; Consumo de Oxigênio; Teste de Esforço; Teste de Caminhada; Atividade Física; Estilo de Vida

Heart failure (HF) is considered a prevalent disease, limiting survival and constituting one of the leading causes of hospitalization or death in several countries, including Brazil.¹ Therefore, clinical classification in patients with HF can be considered important as an initial reference, as it informs the functional condition of these patients. Classically, the subjective classification of the New York Heart Association (NYHA) and the objective classification of Weber² are the most used. The NYHA functional classification and oxygen consumption at peak exertion were decisive in determining the functional condition of patients with Chagas disease.³ However, certain patients with minor symptoms are at high risk of hospitalization or death.⁴

In patients with HF, the 6-minute walk test is also considered in assessing functional and prognostic capacity. This test has a predictive value for mortality in patients with HF functional class II and III (NYHA).⁵

Studies of cardiopulmonary assessment have expanded, simultaneously, to studies of exercise physiology, with better precision in the functional evaluation and, through the parameters obtained in the Cardiopulmonary Exercise Test (CPET), we have prognostic inference variables, which define conducts and guide the prescription of exercises.⁶

The well-designed study by Ritt et al.⁷ analyzed the correlation and agreement between NYHA classes and CPET variables. The most studied variables today were highlighted.¹ We suggest, as a continuation of the study, to include correlations with Circulatory Power (Maximum Systolic Blood Pressure x V’O2 peak)⁸ and V’O2 at the threshold I,⁹ parameters that determine prognostic perspectives and, as a future study, the risk score to predict post-discharge mortality in patients with HF.¹⁰

We reiterate our congratulations to the authors⁷ for the study and the suggestion for future research aiming at a classification based on the parameters obtained in the CPET, with accuracy for indication of heart transplantation or placement of artificial ventricle.

• Short Editorial related to the article: Low Concordance between NYHA Classification and Cardiopulmonary Exercise Test Variables in Patients with Heart Failure and Reduced Ejection Fraction

References

• ¹ Sociedade Brasileira de Cardiologia. Comitê Coordenador da Diretriz de Insuficiência Cardíaca. Diretriz Brasileira de Insuficiência Cardíaca Crônica e Aguda. Arq Bras Cardiol.2018; 111(3):436-539. doi: 10.5935/abc.20180190.
  » https://doi.org/10.5935/abc.20180190
• ² Weber KT, Kinasewitz GT, Janick JS, Fishman AP. Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure. Circulation.1982;65(6):1213-23. doi:10.1161/01.circ.65.6.1213.
  » https://doi.org/10.1161/01.circ.65.6.1213
• ³ Silva WT, Costa HS, Figueiredo PHS, Lima MMO, Lima VP, Costa FSM, et al. Determinantes da Capacidade Funcional em Pacientes com Doença de Chagas. Arq Bras Cardiol. 2021;117(5): 934-41. doi:https://doi.org/10.36660/abc.20200462
  » https://doi.org/10.36660/abc.20200462
• ⁴ 2021 Esc Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J.2021;42(36):3599-726. doi:10.1093/eurheartj/ehab368.
  » https://doi.org/10.1093/eurheartj/ehab368
• ⁵ Morais ER, Rassi S. Determinants of the distance covered during a six-minute walk test in patients with chronic heart failure. Int J Cardiovasc Sci. 2019;32(2):2019;32(2):134-42. doi: 10.5935/2359-4802.20180088
  » https://doi.org/10.5935/2359-4802.20180088
• ⁶ Ávila DX, Vivacqua RC, Serra S, Montera MW, Tinoco E, Siciliano A. The unsurpassed value of cardiopulmonary exercise testing in assessing the prognosis of heart failure. Eur Heart J.2020;41(Suppl 2):ehaa946.988. https://doi.org/10.1093/ehjci/ehaa946.0988
  » https://doi.org/10.1093/ehjci/ehaa946.0988
• ⁷ Ritt LEF, Ribeiro RS, Souza IPMA, Ramos JVSP, Ribeiro DS, Feitosa GF, et al. Baixa concordância entre a classificação da NYHA e as variáveis do teste de exercício cardiopulmonar em pacientes com insuficiência cardíaca e fração de ejeção reduzida. Arq Bras Cardiol. 2022; 118(6):1118-1123.
• ⁸ Tabet JY, Metra M, Thabut G, Logeart D, Cohen-Solal A. Prognostic value of cardiopulmonary exercise variables in chronic heart failure patients with or without beta-blocker therapy. Am J Cardiol.2006;98(4):500-3. doi: 10.1016/j.amjcard.2006.03.027.
  » https://doi.org/10.1016/j.amjcard.2006.03.027
• ⁹ Lala A, Shah KB, Lanfear E, Thibodeau JT, Palardy M, et al. Predictive value of cardiopulmonary exercise testing parameters in ambulatory advanced heart failure. J Am Coll Cardiol HF 2021;9:226-236-36. doi:https://doi.org/10.1016/j.chf.2020.11.008
  » https://doi.org/10.1016/j.chf.2020.11.008
• ¹⁰ Lei Wang, Li-Oin Wang, Mo-Li Gu, Liang Li, Chen Wang, Yun-Feng Xia. Escore de risco clínico simples para prever a mortalidade pós-alta hospitalar em pacientes chineses hospitalizados por insuficiência cardíaca. Arq Bras Cardiol.2021;117(4):615-23. doi:10.36660/abc.20200435.
  » https://doi.org/10.36660/abc.20200435

Publication Dates

• Publication in this collection
  10 June 2022
• Date of issue
  2022