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

• Published in: International journal of cardiology Vol. 263; pp. 88 - 93
• Main Authors: Lim, Fang Yi, Yap, Jonathan, Gao, Fei, Teo, Ling Li, Lam, Carolyn S.P., Yeo, Khung Keong
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.07.2018
• Subjects: Cardiopulmonary Exercise Test; Case-Control Studies; Exercise Test - classification; Exercise Test - standards; Functional classification; Heart failure; Heart Failure - classification; Heart Failure - diagnosis; Heart Failure - physiopathology; Humans; New York; New York Heart Association; Oxygen Consumption - physiology; Peak oxygen consumption; Societies, Medical - standards; Heart failure; New York Heart Association; Functional classification; Peak oxygen consumption; Cardiopulmonary Exercise Test
• ISSN: 0167-5273; 1874-1754; 1874-1754
• DOI: 10.1016/j.ijcard.2018.04.021

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. 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. 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. •General inverse correlation between NYHA I–III and pVO2 on CPET in patients with heart failure•Significant heterogeneity across studies in pVO2 within each NYHA class•Overlap in pVO2 between NYHA III and IV•Subjectivity of NYHA classification may limit comparisons across studies•Objective CPET may be particularly useful in assessing patients with poor functional status.