PMID- 33361353
OWN - NLM
STAT- MEDLINE
DCOM- 20211207
LR  - 20211214
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 107
IP  - 18
DP  - 2021 Sep
TI  - Revisiting heart failure assessment based on objective measures in NYHA 
      functional classes I and II.
PG  - 1487-1492
LID - 10.1136/heartjnl-2020-317984 [doi]
AB  - 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 
      Insuficiencia Cardiaca (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.
CI  - (c) Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Blacher, Mariana
AU  - Blacher M
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de 
      Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
FAU - Zimerman, Andre
AU  - Zimerman A
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de 
      Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Engster, Pedro H B
AU  - Engster PHB
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Grespan, Eduardo
AU  - Grespan E
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Polanczyk, Carisi A
AU  - Polanczyk CA
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de 
      Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Rover, Marciane M
AU  - Rover MM
AD  - Instituto de Cardiologia, Porto Alegre, Brazil.
FAU - Neto, Jose A de Figueiredo
AU  - Neto JAF
AD  - Universidade Federal do Maranhao, Sao Luis, Maranhao, Brazil.
FAU - Danzmann, Luiz C
AU  - Danzmann LC
AD  - Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil.
FAU - Bertoldi, Eduardo G
AU  - Bertoldi EG
AD  - Universidade Federal de Pelotas, Pelotas, Brazil.
FAU - Simoes, Marcus Vinicius
AU  - Simoes MV
AD  - Faculdade de Medicina de Ribeirao Preto, Universidade de Sao Paulo, Sao Paulo, 
      Brazil.
FAU - Beck-da-Silva, Luis
AU  - Beck-da-Silva L
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de 
      Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Biolo, Andreia
AU  - Biolo A
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de 
      Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Rohde, Luis E
AU  - Rohde LE
AUID- ORCID: 0000-0002-6557-393X
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Faculdade de 
      Medicina da Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil 
      rohde.le@gmail.com.
AD  - Cardiovascular Division, Hospital Moinhos de Vento, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
LA  - eng
SI  - ClinicalTrials.gov/NCT02689180
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20201223
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Biomarkers)
RN  - 0 (Peptide Fragments)
RN  - 0 (Protein Precursors)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Biomarkers/blood
MH  - Female
MH  - Heart Failure/*classification/diagnosis/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/*blood
MH  - *Outpatients
MH  - Peptide Fragments/*blood
MH  - Protein Precursors
MH  - Stroke Volume/*physiology
MH  - Ventricular Function, Left/*physiology
OTO - NOTNLM
OT  - heart failure with reduced ejection fraction
COIS- Competing interests: None declared.
EDAT- 2020/12/29 06:00
MHDA- 2021/12/15 06:00
CRDT- 2020/12/28 11:41
PHST- 2020/08/07 00:00 [received]
PHST- 2020/11/11 00:00 [revised]
PHST- 2020/11/16 00:00 [accepted]
PHST- 2020/12/29 06:00 [pubmed]
PHST- 2021/12/15 06:00 [medline]
PHST- 2020/12/28 11:41 [entrez]
AID - heartjnl-2020-317984 [pii]
AID - 10.1136/heartjnl-2020-317984 [doi]
PST - ppublish
SO  - Heart. 2021 Sep;107(18):1487-1492. doi: 10.1136/heartjnl-2020-317984. Epub 2020 
      Dec 23.