Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart Failure: A Cohort Study

Engster, Pedro Henrique de Borba; Zimerman, André; Schaan, Thomas; Borges, Marina S.; Souza, Gabriel; Costa, Giovanni Donelli; Rohde, Luis Eduardo; Silveira, Anderson Donelli da

doi:10.36660/abc.20230077

person Pedro Henrique de Borba Engster

Conception and design of the research · Acquisition of data · Analysis and interpretation of the data · Statistical analysis; · Obtaining financing · Writing of the manuscript · Critical revision of the manuscript for important intellectual content

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil

0000-0001-7784-623X

person André Zimerman

Conception and design of the research · Acquisition of data · Analysis and interpretation of the data · Statistical analysis · Obtaining financing · Writing of the manuscript · Critical revision of the manuscript for important intellectual content

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil school Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil school Harvard Medical School, Boston, Massachusetts – EUA

0000-0001-8977-6929

person Thomas Schaan

Conception and design of the research · Acquisition of data · Analysis and interpretation of the data · Writing of the manuscript

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil school Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil

person Marina S. Borges

Acquisition of data · Analysis and interpretation of the data · Statistical analysis · Writing of the manuscript

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil school Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil

0000-0002-1816-6602

person Gabriel Souza

Acquisition of data · Analysis and interpretation of the data · Statistical analysis · Writing of the manuscript

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil school Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil

person Giovanni Donelli Costa

Acquisition of data · Analysis and interpretation of the data · Writing of the manuscript

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil school Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil

person Luis Eduardo Rohde

Conception and design of the research · Acquisition of data · Analysis and interpretation of the data · Writing of the manuscript · Critical revision of the manuscript for important intellectual content

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil school Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil school Hospital Moinhos de Vento – Cardiologia, Porto Alegre, RS – Brasil

0000-0002-6557-393X

person Anderson Donelli da Silveira

Conception and design of the research · Acquisition of data · Analysis and interpretation of the data · Statistical analysis · Obtaining financing · Writing of the manuscript; · Critical revision of the manuscript for important intellectual content

school Universidade Federal do Rio Grande do Sul – FAMED, Porto Alegre, RS – Brasil school Hospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil school Hospital Moinhos de Vento – Cardiologia, Porto Alegre, RS – Brasil

0000-0002-0327-3392

Mailing Address: Anderson Donelli da Silveira • Hospital de Clinicas de Porto Alegre – Rua Ramiro Barcelos, 2350. Postal Code 90035-903, Porto Alegre, RS – Brazil E-mail: dededonelli@gmail.com

Potential conflict of interest

No potential conflict of interest relevant to this article was reported.

Editor responsible for the review: Gláucia Maria Moraes de Oliveira

Figures (5)
Tables (2)

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Figura Central : Papel Incremental da Classificação da New York Heart Association e dos Índices do Teste de Exercício Cardiopulmonar para Prognóstico na Insuficiência Cardíaca: um Estudo de Coorte

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Central Illustration : Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart Failure: A Cohort Study

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Figure 1 – Overall survival for patients with concordant NYHA and Weber classes. Notes: Kaplan-Meier curve displaying time to all-cause death. Favorable NYHA class was defined as NYHA I or II; adverse NYHA class was defined as NYHA III or IV. Favorable Weber class was defined as Weber A or B; adverse Weber class was defined as Weber C or D. Patients with the same classification (either favorable or adverse) in both classes were classified as concordant and included in this analysis. CI: confidence interval; HR: hazard ratio; NYHA: New York Heart Association.

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Figure 2 – Overall survival for patients with discordant NYHA and Weber classes. Notes: Kaplan-Meier curve displaying time to all-cause death. Favorable NYHA class was defined as NYHA I or II; adverse NYHA class was defined as NYHA III or IV. Favorable Weber class was defined as Weber A or B; adverse Weber class was defined as Weber C or D. Patients with one favorable class and one adverse class were classified as discordant and included in this analysis. CI: confidence interval; HR: hazard ratio; NYHA: New York Heart Association.

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Figure 3 – Predicted probability of mortality at 5 years by NYHA class and peak VO 2 . Predicted probability of mortality for a male patient of age 57.2 years. NYHA: New York Heart Association; VO 2 : oxygen consumption.

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Table 1 – Baseline characteristics

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Table 2 – CPET parameters by NYHA class

Caracteristics*	NYHA I (N=246)	NYHA II (N=362)	NYHA III (N=197)	NYHA IV (N=29)	Overall (N=834)	p value
Age, years	57.1 (48.0-64.0)	56.8 (48.9-63.4)	58.2 (49.8-65.7)	56.1 (49.0-62.6)	57.1 (49.0-64.1)	0.346
Female sex	89 (36.2%)	151 (41.7%)	98 (49.7%)	13 (44.8%)	351 (42.1%)	0.039
Body mass index, kg/m ²	26.1 (23.9-29.4)	28.2 (24.4-32.6)	27.7 (23.9-31.8)	26.6 (24.7-29.4)	27.4 (24.1-31.6)	0.004
Hypertension	117 (47.6%)	200 (55.2%)	108 (54.8%)	12 (41.4%)	437 (52.4%)	0.15
Diabetes	65 (26.4%)	120 (33.1%)	72 (36.5%)	11 (37.9%)	268 (32.1%)	0.11
Atrial fibrillation	43 (17.5%)	71 (19.6%)	50 (25.4%)	8 (27.6%)	172 (20.6%)	0.15
LVEF, %	34.0 (25.0-45.3)	32.0 (25.0-45.0)	30.0 (23.0-38.0)	28.0 (20.0-53.0)	32.0 (25.0-43.0)	0.003
LVEF < 40%	150 (61.0%)	239 (66.0%)	149 (75.6%)	20 (69.0%)	558 (66.9%)
LVEF 40.0% to 49.9%	42 (17.1%)	53 (14.6%)	19 (9.6%)	1 (3.4%)	115 (13.8%)
LVEF ≥ 50%	52 (21.1%)	63 (17.4%)	24 (12.2%)	8 (27.6%)	147 (17.6%)
Ischemic cardiomyopathy	59 (24.0%)	111 (30.7%)	72 (36.5%)	8 (27.6%)	250 (30.0%)	0.038
Beta blocker use	228 (92.7%)	345 (95.3%)	182 (92.4%)	26 (89.7%)	781 (93.6%)	0.34
ACEI or ARB use	214 (87.0%)	304 (84.0%)	157 (79.7%)	16 (55.2%)	691 (82.9%)	<0.001
Spironolactone use	137 (55.7%)	229 (63.3%)	125 (63.5%)	14 (48.3%)	505 (60.6%)	0.11

Caracteristics	NYHA I (N=246)	NYHA II (N=362)	NYHA III (N=197)	NYHA IV (N=29)	Overall (N=834)	p value
Peak VO ₂ , ml/kg/min	19.1 (15.7-23.0)	17.4 (14.5-21.0)	15.3 (12.6-18.1)	13.6 (12.3-16.1)	17.2 (14.2-21.0)	<0.001
Weber class						<0.001
A (> 20 ml/kg/min)	107 (43%)	114 (31.5%)	27 (13.7%)	1 (3.4%)	249 (29.9%)
B (16 to 20 ml/kg/min)	67 (27.2%)	112 (30.9%)	56 (28.4%)	7 (24.1%)	242 (29.0%)
C (10 to 15.9 ml/kg/min)	71 (28.9%)	131 (36.2%)	101 (51.3%)	19 (65.5%)	322 (38.6%)
D (< 10 ml/kg/min)	1 (0.4%)	5 (1.4%)	13 (6.6%)	2 (6.9%)	21 (2.5%)
VE/VCO ₂ slope	36.7 (31.2-42.7)	37.2 (32.7-44.2)	41.0 (35.5-48.8)	49.8 (43.1-57.4)	38.1 (33.3-45.5)	<0.001
VE/VCO ₂ < 30	46 (18.7%)	57 (15.7%)	17 (8.6%)	1 (3.4%)	121 (14.5%)
VE/VCO ₂ 30 to 35.9	48 (19.5%)	84 (23.2%)	66 (33.5%)	19 (65.5%)	217 (26.0%)
VE/VCO ₂ 36 to 44.9	66 (26.8%)	92 (25.4%)	36 (18.3%)	0 (0%)	194 (23.3%)
VE/VCO ₂ > 45	86 (35.0%)	129 (35.6%)	76 (38.6%)	9 (31.0%)	300 (36.0%)
OUES	1.38 (1.11-1.88)	1.40 (1.01-1.76)	1.18 (0.861-1.56)	1.07 (0.827-1.19)	1.31 (0.990-1.72)	<0.001
OUES > 1.4	118 (48%)	178 (49.2%)	68 (34.5%)	3 (10.3%)	367 (44.0%)
Percent-predicted peak VO ₂	0.67 (0.55-0.77)	0.64 (0.54-0.76)	0.58 (0.47-0.68)	0.48 (0.40-0.62)	0.63 (0.52-0.74)	<0.001
Percent-predicted peak VO ₂ < 50%	38 (15.4%)	70 (19.3%)	60 (30.5%)	15 (51.7%)	183 (21.9%)
Percent-predicted peak VO ₂ ≥ 75%	72 (29.3%)	92 (25.4%)	30 (15.2%)	1 (3.4%)	195 (23.4%)

[TFN1001] * Continuous data are displayed as median (Q1-Q3); categorical data are displayed as N (%). Sodium-glucose cotransporter-2 inhibitors were not used. ACEI angiotensin converting enzyme inhibitor; ARB: angiotensin receptor blocker; LVEF: left ventricular ejection fraction; NYHA: New York Heart Association. Missing measurements accounted for 1.7% or less of each variable.

Incremental Role of New York Heart Association Class and Cardiopulmonary Exercise Test Indices for Prognostication in Heart Failure: A Cohort Study

Abstract