PMID- 36808902
OWN - NLM
STAT- MEDLINE
DCOM- 20230519
LR  - 20230919
IS  - 2055-5822 (Electronic)
IS  - 2055-5822 (Linking)
VI  - 10
IP  - 3
DP  - 2023 Jun
TI  - Functional assessment based on cardiopulmonary exercise testing in mild heart 
      failure: A multicentre study.
PG  - 1689-1697
LID - 10.1002/ehf2.14287 [doi]
AB  - AIMS: In this multicentre study, we compared cardio-pulmonary exercise test 
      (CPET) parameters between heart failure (HF) patients classified as New York 
      Heart Association (NYHA) class I and II to assess NYHA performance and prognostic 
      role in mild HF. METHODS AND RESULTS: We included consecutive HF patients in NYHA 
      class I or II who underwent CPET in three Brazilian centres. We analysed the 
      overlap between kernel density estimations for the per cent-predicted peak oxygen 
      consumption (VO(2) ), minute ventilation/carbon dioxide production (VE/VCO(2) ) 
      slope, and oxygen uptake efficiency slope (OUES) by NYHA class. Area under the 
      receiver-operating characteristic curve (AUC) was used to assess the capacity of 
      per cent-predicted peak VO(2) to discriminate between NYHA class I and II. For 
      prognostication, time to all-cause death was used to produce Kaplan-Meier 
      estimates. Of 688 patients included in this study, 42% were classified as NYHA I 
      and 58% as NYHA II, 55% were men, and mean age was 56 years. Median global per 
      cent-predicted peak VO(2) was 66.8% (IQR 56-80), VE/VCO(2) slope was 36.9 
      (31.6-43.3), and mean OUES was 1.51 (+/-0.59). Kernel density overlap between NYHA 
      class I and II was 86% for per cent-predicted peak VO(2) , 89% for VE/VCO(2) 
      slope, and 84% for OUES. Receiving-operating curve analysis showed a significant, 
      albeit limited performance of per cent-predicted peak VO(2) alone to discriminate 
      between NYHA class I vs. II (AUC 0.55, 95% CI 0.51-0.59, P = 0.005). Model 
      accuracy for probability of being classified as NYHA class I (vs. NYHA class II) 
      across the spectrum of the per cent-predicted peak VO(2) was limited, with an 
      absolute probability increment of 13% when per cent-predicted peak VO(2) 
      increased from 50% to 100%. Overall mortality in NYHA class I and II was not 
      significantly different (P = 0.41), whereas NYHA class III patients displayed a 
      distinctively higher death rate (P < 0.001). CONCLUSIONS: Patients with chronic 
      HF classified as NYHA I overlapped substantially with those classified as NYHA II 
      in objective physiological measures and prognosis. NYHA classification may 
      represent a poor discriminator of cardiopulmonary capacity in patients with mild 
      HF.
CI  - (c) 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on 
      behalf of European Society of Cardiology.
FAU - Zimerman, Andre
AU  - Zimerman A
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, 
      Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - da Silveira, Anderson D
AU  - da Silveira AD
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, 
      Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Borges, Marina S
AU  - Borges MS
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 - Schaan, Thomas U
AU  - Schaan TU
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - de Souza, Gabriel C
AU  - de Souza GC
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - de Souza, Isabela P M A
AU  - de Souza IPMA
AD  - Escola Bahiana de Medicina e Saude Publica, Salvador, Brazil.
FAU - Ritt, Luiz Eduardo F
AU  - Ritt LEF
AD  - Instituto D'Or de Pesquisa e Ensino e Hospital Cardio Pulmonar, Salvador, Brazil.
FAU - Stein, Ricardo
AU  - Stein R
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, 
      Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
FAU - Berwanger, Otavio
AU  - Berwanger O
AD  - Academic Research Organization, Hospital Israelita Albert Einstein, Sao Paulo, 
      Brazil.
FAU - Vaduganathan, Muthiah
AU  - Vaduganathan M
AD  - Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, 
      USA.
FAU - Rohde, Luis Eduardo
AU  - Rohde LE
AD  - Post-Graduate Program in Cardiology and Cardiovascular Sciences, Medical School, 
      Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
AD  - Cardiovascular Division, Hospital de Clinicas de Porto Alegre, Porto Alegre, 
      Brazil.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20230221
PL  - England
TA  - ESC Heart Fail
JT  - ESC heart failure
JID - 101669191
SB  - IM
MH  - Male
MH  - Humans
MH  - Middle Aged
MH  - Female
MH  - *Exercise Test
MH  - Oxygen Consumption/physiology
MH  - *Heart Failure
MH  - Prognosis
MH  - Chronic Disease
PMC - PMC10192241
OTO - NOTNLM
OT  - Cardiopulmonary exercise test
OT  - Functional class
OT  - Heart failure
OT  - New York heart association
COIS- Dr Berwanger reported grants from AstraZeneca, Pfizer, Bayer, Amgen, Servier, 
      Bristol Myers Squibb, and Boehringer Ingelheim. Dr Vaduganathan has received 
      research grant support or served on advisory boards for American Regent, Amgen, 
      AstraZeneca, Bayer AG, Baxter Healthcare, Boehringer Ingelheim, Cytokinetics, and 
      Relypsa, and participates on clinical endpoint committees for studies sponsored 
      by Galmed, Novartis, and the NIH. Dr Rohde has been a consultant or served on 
      advisory board for Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Merck, 
      Novartis and Pfizer.
EDAT- 2023/02/23 06:00
MHDA- 2023/05/19 06:42
PMCR- 2023/02/21
CRDT- 2023/02/22 13:24
PHST- 2022/10/25 00:00 [revised]
PHST- 2022/08/17 00:00 [received]
PHST- 2023/01/09 00:00 [accepted]
PHST- 2023/05/19 06:42 [medline]
PHST- 2023/02/23 06:00 [pubmed]
PHST- 2023/02/22 13:24 [entrez]
PHST- 2023/02/21 00:00 [pmc-release]
AID - EHF214287 [pii]
AID - 10.1002/ehf2.14287 [doi]
PST - ppublish
SO  - ESC Heart Fail. 2023 Jun;10(3):1689-1697. doi: 10.1002/ehf2.14287. Epub 2023 Feb 
      21.