Correlation of the New York Heart Association classification and the cardiopulmonary exercise test: A systematic review

Fang Yi Lim, Jonathan Yap, Fei Gao, Ling Li Teo, Carolyn S. P. Lam, Khung Keong Yeo*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)

Abstract

Aims: The New York Heart Association (NYHA) classification is frequently used in the management of heart failure but may be limited by patient and physician subjectivity. Cardiopulmonary exercise testing (CPET) provides a potentially more objective measurement of functional status. We aim to study the correlation between NYHA classification and peak oxygen consumption (pVO(2)) on Cardiopulmonary Exercise Testing (CPET) within and across published studies.

Methods and results: A systematic literature review on all studies reporting both NYHA class and CPET data was performed, and pVO(2) from CPET was correlated to reported NYHA class within and across eligible studies. 38 studies involving 2645 patients were eligible. Heterogenity was assessed by the Q statistic, which is a chi(2) test and marker of systematic differences between studies. Within each NYHA class, significant heterogeneity in pVO(2) was seen across studies: NYHA I (n = 17, Q = 486.7, p <0.0001), II (n = 24, Q = 381.0, p <0.0001), III (n = 32, Q = 7613, p <0.0001) and IV (n = 5, Q = 12.8, p = 0.012). Significant differences in mean pVO(2) were observed between NYHA I and 11 (23,8 vs 17.6 mL/(kg.min), p <0.0001) and II and III (17.6 vs 13.3 mL/(kg.min), p <0.0001); but not between NYHA III and IV (13.3 vs 12.5 mL(kg.min), p 045). These differences remained significant after adjusting for age, gender, ejection fraction and region of study.

Conclusion: There was a general inverse correlation between NYHA class and pVO(2); However, significant heterogeneity in pVO(2) exists across studies within each NYHA class. While the NYHA classification holds clinical value in heart failure management, died comparison across studies may have its limitations. (C) 2018 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)88-93
Number of pages6
JournalInternational Journal of Cardiology
Volume263
DOIs
Publication statusPublished - 15-Jul-2018

Keywords

  • New York Heart Association
  • Heart failure
  • Functional classification
  • Cardiopulmonary Exercise Test
  • Peak oxygen consumption
  • PEAK OXYGEN-CONSUMPTION
  • LEFT-VENTRICULAR FUNCTION
  • 6-MINUTE WALK TEST
  • DILATED CARDIOMYOPATHY
  • FAILURE PATIENTS
  • FUNCTIONAL-EVALUATION
  • AEROBIC CAPACITY
  • PROGNOSTIC VALUE
  • SKELETAL-MUSCLE
  • NORDIC WALKING

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