PMID- 38126514
OWN - NLM
STAT- MEDLINE
DCOM- 20231222
LR  - 20240110
IS  - 1678-4170 (Electronic)
IS  - 0066-782X (Print)
IS  - 0066-782X (Linking)
VI  - 120
IP  - 11
DP  - 2023 Nov
TI  - Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise 
      Test Indices for Prognostication in Heart Failure: A Cohort Study.
PG  - e20230077
LID - S0066-782X2023001100309 [pii]
LID - 10.36660/abc.20230077 [doi]
LID - e20230077
AB  - BACKGROUND: Central Illustration : Incremental Role of New York Heart Association 
      Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart 
      Failure: A Cohort Study LVEF: left ventricular ejection fraction; HR: hazard 
      ratio; CI: confidence interval; NYHA: New York Heart Association; VO 2: oxygen 
      consumption. BACKGROUND: The accuracy of the New York Heart Association (NYHA) 
      classification to assess prognosis may be limited compared with objective 
      cardiopulmonary exercise test (CPET) parameters in heart failure (HF). OBJECTIVE: 
      To investigate the prognostic value of the NYHA classification in addition to 
      Weber class. METHODS: Adult outpatients with HF undergoing CPET in a Brazilian 
      tertiary care center were included. The physician-assigned NYHA class and the 
      CPET-derived Weber class were stratified into "favorable" (NYHA I or II; Weber A 
      or B) or "adverse" (NYHA III or IV; Weber C or D). Patients with one favorable 
      class and one adverse class were defined as "discordant." The primary endpoint 
      was time to all-cause mortality. A 2-sided p value < 0.05 was considered 
      statistically significant. RESULTS: A total of 834 patients were included. Median 
      age was 57 years; 42% (351) were female, and median left ventricular ejection 
      fraction was 32%. Among patients with concordant NYHA and Weber classes, those 
      with adverse NYHA and Weber classes had significantly higher all-cause mortality 
      compared to those with favorable classes (hazard ratio [HR]: 5.65; 95% confidence 
      interval [CI]: 3.38 to 9.42). Among patients with discordant classes, there was 
      no significant difference in all-cause mortality (HR: 1.38; 95% CI: 0.82 to 
      2.34). In the multivariable model, increments in NYHA class (HR: 1.55 per class 
      increase; 95% CI: 1.26 to 1.92) and reductions in peak VO 2 (HR: 1.47 per 3 
      ml/kg/min decrease; 95% CI: 1.28 to 1.70) significantly predicted mortality. 
      CONCLUSIONS: Physician-assigned NYHA class and objective CPET measures provide 
      complementary prognostic information for patients with HF.
FAU - Engster, Pedro Henrique de Borba
AU  - Engster PHB
AUID- ORCID: 0000-0001-7784-623X
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
FAU - Zimerman, Andre
AU  - Zimerman A
AUID- ORCID: 0000-0001-8977-6929
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
AD  - Hospital de Clinicas de Porto Alegre , Porto Alegre , RS - Brasil.
AD  - Harvard Medical School , Boston , Massachusetts - EUA.
FAU - Schaan, Thomas
AU  - Schaan T
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
AD  - Hospital de Clinicas de Porto Alegre , Porto Alegre , RS - Brasil.
FAU - Borges, Marina S
AU  - Borges MS
AUID- ORCID: 0000-0002-1816-6602
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
AD  - Hospital de Clinicas de Porto Alegre , Porto Alegre , RS - Brasil.
FAU - Souza, Gabriel
AU  - Souza G
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
AD  - Hospital de Clinicas de Porto Alegre , Porto Alegre , RS - Brasil.
FAU - Costa, Giovanni Donelli
AU  - Costa GD
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
AD  - Hospital de Clinicas de Porto Alegre , Porto Alegre , RS - Brasil.
FAU - Rohde, Luis Eduardo
AU  - Rohde LE
AUID- ORCID: 0000-0002-6557-393X
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
AD  - Hospital de Clinicas de Porto Alegre , Porto Alegre , RS - Brasil.
AD  - Hospital Moinhos de Vento - Cardiologia, Porto Alegre , RS - Brasil.
FAU - Silveira, Anderson Donelli da
AU  - Silveira ADD
AUID- ORCID: 0000-0002-0327-3392
AD  - Universidade Federal do Rio Grande do Sul - FAMED , Porto Alegre , RS - Brasil.
AD  - Hospital de Clinicas de Porto Alegre , Porto Alegre , RS - Brasil.
AD  - Hospital Moinhos de Vento - Cardiologia, Porto Alegre , RS - Brasil.
LA  - por
LA  - eng
PT  - Journal Article
TT  - Papel Incremental da Classificacao da New York Heart Association e dos Indices do 
      Teste de Exercicio Cardiopulmonar para Prognostico na Insuficiencia Cardiaca: um 
      Estudo de Coorte.
PL  - Brazil
TA  - Arq Bras Cardiol
JT  - Arquivos brasileiros de cardiologia
JID - 0421031
SB  - IM
MH  - Adult
MH  - Humans
MH  - Female
MH  - Middle Aged
MH  - Male
MH  - *Exercise Test
MH  - Cohort Studies
MH  - Stroke Volume
MH  - New York
MH  - Ventricular Function, Left
MH  - *Heart Failure
MH  - Prognosis
PMC - PMC10773458
OAB - 
OABL- eng
OAB - BACKGROUND: The accuracy of the New York Heart Association (NYHA) classification 
      to assess prognosis may be limited compared with objective cardiopulmonary 
      exercise test (CPET) parameters in heart failure (HF). OBJECTIVE: To investigate 
      the prognostic value of the NYHA classification in addition to Weber class. 
      METHODS: Adult outpatients with HF undergoing CPET in a Brazilian tertiary care 
      center were included. The physician-assigned NYHA class and the CPET-derived 
      Weber class were stratified into "favorable" (NYHA I or II; Weber A or B) or 
      "adverse" (NYHA III or IV; Weber C or D). Patients with one favorable class and 
      one adverse class were defined as "discordant." The primary endpoint was time to 
      all-cause mortality. A 2-sided p value < 0.05 was considered statistically 
      significant. RESULTS: A total of 834 patients were included. Median age was 57 
      years; 42% (351) were female, and median left ventricular ejection fraction was 
      32%. Among patients with concordant NYHA and Weber classes, those with adverse 
      NYHA and Weber classes had significantly higher all-cause mortality compared to 
      those with favorable classes (hazard ratio [HR]: 5.65; 95% confidence interval 
      [CI]: 3.38 to 9.42). Among patients with discordant classes, there was no 
      significant difference in all-cause mortality (HR: 1.38; 95% CI: 0.82 to 2.34). 
      In the multivariable model, increments in NYHA class (HR: 1.55 per class 
      increase; 95% CI: 1.26 to 1.92) and reductions in peak VO (2) (HR: 1.47 per 3 
      ml/kg/min decrease; 95% CI: 1.28 to 1.70) significantly predicted mortality. 
      CONCLUSIONS: Physician-assigned NYHA class and objective CPET measures provide 
      complementary prognostic information for patients with HF.
OABL- eng
COIS- Potencial conflito de interesse Nao ha conflito com o presente artigo
EDAT- 2023/12/21 12:43
MHDA- 2023/12/22 06:42
PMCR- 2023/12/06
CRDT- 2023/12/21 08:04
PHST- 2023/02/04 00:00 [received]
PHST- 2023/09/13 00:00 [accepted]
PHST- 2023/12/22 06:42 [medline]
PHST- 2023/12/21 12:43 [pubmed]
PHST- 2023/12/21 08:04 [entrez]
PHST- 2023/12/06 00:00 [pmc-release]
AID - S0066-782X2023001100309 [pii]
AID - 10.36660/abc.20230077 [doi]
PST - ppublish
SO  - Arq Bras Cardiol. 2023 Nov;120(11):e20230077. doi: 10.36660/abc.20230077.