Arq. Bras. Cardiol. 2022; 118(6): 1118-1123
Low Concordance between NYHA Classification and Cardiopulmonary Exercise Test Variables in Patients with Heart Failure and Reduced Ejection Fraction
Luiz Eduardo Fonteles Ritt
, Rebeca Sadigursky Ribeiro, Isabela Pilar Moraes Alves de Souza
, João Victor Santos Pereira Ramos
, Daniel Sadigursky Ribeiro, Gustavo Freitas Feitosa, Queila Borges de Oliveira, Ricardo Stein
, Eduardo Sahade Darzé
This Original Article is referred by the Short Editorial "NYHA Classification and Cardiopulmonary Exercise Test Variables in Patients with Heart Failure".
Abstract
Background
The New York Heart Association (NYHA) functional classification is the most commonly used classification system for heart failure (HF), whereas cardiopulmonary exercise testing (CPET) is the gold standard for functional status evaluation in HF.
Objective
This study aimed to analyze correlation and concordance between NYHA classes and CPET variables.
Methods
HF patients with clinical indication for CPET and ejection fraction (EF) < 50% were selected. Correlation (Spearman coefficient) and concordance (kappa) between NYHA classification and CPET-based classifications were analyzed. A p < 0.05 was accepted as significant.
Results
In total, 244 patients were included. Mean age was 56 ± 14 years, and mean EF was 35.5% ± 10%. Distribution of patients according to NYHA classification was 31.2%% class I, 48.3% class II, 19.2% class III, and 1.3% class IV. Correlation (r) between NYHA and Weber classes was 0.489 (p < 0.001), and concordance was 0.231 (p < 0.001). Correlation (r) between NYHA and ventilatory classes (minute ventilation/carbon dioxide production [VE/VCO2] slope) was 0.218 (p < 0.001), and concordance was 0.002 (p = 0.959). Spearman correlation between NYHA and CPET score classes was 0.223 (p = 0.004), and kappa concordance was 0.027 (p = 0.606).
Conclusion
There was a moderate association between NYHA and Weber classes, although concordance was low. Ventilatory (VE/VCO2slope) and CPET score classes had a weak association and a low concordance with NYHA classes.
Keywords: Exercise Test; Heart failure; Prognosis
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