Fang Yi Lim1, Jonathan Yap1, Fei Gao2, Ling Li Teo1, Carolyn S P Lam3, Khung Keong Yeo4. 1. Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore. 2. Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore. 3. Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore; University Medical Centre Groningen, Hanzeplein 1, 9713, GZ, Groningen, Netherlands. 4. Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore; Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857, Singapore. Electronic address: yeo.khung.keong@nhcs.com.sg.
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 (pVO2) 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 pVO2 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 χ2 test and marker of systematic differences between studies. Within each NYHA class, significant heterogeneity in pVO2 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 = 761.3, p < 0.0001) and IV (n = 5, Q = 12.8, p = 0.012). Significant differences in mean pVO2 were observed between NYHA I and II (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 = 0.45). 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 pVO2. However, significant heterogeneity in pVO2 exists across studies within each NYHA class. While the NYHA classification holds clinical value in heart failure management, direct comparison across studies may have its limitations.
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 (pVO2) 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 pVO2 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 χ2 test and marker of systematic differences between studies. Within each NYHA class, significant heterogeneity in pVO2 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 = 761.3, p < 0.0001) and IV (n = 5, Q = 12.8, p = 0.012). Significant differences in mean pVO2 were observed between NYHA I and II (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 = 0.45). 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 pVO2. However, significant heterogeneity in pVO2 exists across studies within each NYHA class. While the NYHA classification holds clinical value in heart failure management, direct comparison across studies may have its limitations.
Authors: Nirmish Shah; David Beenhouwer; Michael S Broder; Lanetta Bronte-Hall; Laura M De Castro; Sarah N Gibbs; Victor R Gordeuk; Julie Kanter; Elizabeth S Klings; Thokozeni Lipato; Deepa Manwani; Brigid Scullin; Irina Yermilov; Wally R Smith Journal: Clinicoecon Outcomes Res Date: 2020-10-28
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