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2008, Number 2

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Arch Cardiol Mex 2008; 78 (2)

Clinical-hemodynamic correlation of the NYHA/WHO system in idiopathic pulmonary artery hypertension. Clinical, therapeutic, and long-term prognosis implications

Lupi HE, Sandoval ZJ, Figueroa SJ, Santos MLE, Pulido ZTR, Bautista BEG

Language: Spanish
References: 51
Page: 148-161
PDF size: 165.49 Kb.


ABSTRACT

Background: The most often used functional classification for categorizing the degree of cardiac disability in patients with chronic left ventricular failure is the NYHA/WHO system . In Idiopathic Pulmonary Arterial Hypertension [I-PAH], this system although used, has not been studied in detail regarding pulmonary hemodynamic parameters association and for long-term prognosis in each of the NYHA/WHO classes. Methods: We retrospectively, studied the NYHA/WHO system in 83 I-PAH patients. Patients were separated according to the response in the acute vasodilator trial in responders [n = 30] and nonresponders [n = 53]. Results: Classes I – II did not represent the minority population for I-PAH patients [58/83 = 60%]. Only mean right atrial pressure [mRAP] and mean pulmonary artery pressure [mPAP] were different among the NYHA/WHO functional classes [p ‹ 0.000 and p ‹ 0.012; respectively]. I-PAH patients class I have the probability to be a responder 12.6 times more [CI 95.%: 4.59-40.62; p ‹ 0.000]. The long-term mortality for class I patients was 0.%, for class II: 2.%, for class III: 28.% and for class IV: 63.% [p ‹ 0.0001]. The follow-up change for one grade class of the NYHA/WHO classes at four years was noticed only in 20.% of the I-PAH patients. Conclusions: NYHA/WHO classes I-II did not represent the minority of I-PAH patients population as has been previously considered. Only mRAP and mPAP were different among the NYHA/WHO classes. The NYHA/WHO system on the basis of mRAP and mPAP allows to separate classes I–II from III-IV. I-PAH patients class I have 12.6 times more the probability to be a responder and better long-term survival; irrespective of the treatment the prognosis seems to be excellent for this functional class group patients.


REFERENCES

  1. The criteria Committee of the New York Association, Inc: Diseases of the heart and blood vessels; Nomenclature and Criteria for Diagnosis, 6th ed. Boston, Little, Brown, 1964.

  2. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GF, et al: ACC/AHA Guidelines for the evaluation and management of Chronic Heart Failure in adult: Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines [Committee to revise the 1995 Guidelines for the evaluation and management of heart failure]. Circulation 2001; 104: 2996-3007.

  3. Chatterjee K: Vasodilator therapy for heart failure. Ann Intern Med 1975; 83: 421-423.

  4. Zelis R, Flaim SF: Alterations in vasomotor tone in congestive heart failure. Prog Cardiovasc Dis 1982; 24: 437-459.

  5. Mason DT, Zelis R, Longhurst J, Lee G: Cardiocirculatory responses to muscular exercise in congestive heart failure. Prog Cardiovasc Dis 1977; 19: 475-489.

  6. Tan LB: Clinical and research implications of new concepts in the assessment of cardiac pumping performance in heart failure. Cardiovasc Research 1987; 21: 615-622.

  7. Benge W, Litchfield RL, Marcus ML: Exercise Capacity in patients with severe left ventricular dysfunction. Circulation 1980; 60: 955-959.

  8. Franciosa JA, Park M, Levine TB: Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure. Am J Cardiol 1981; 47: 33-39.

  9. Tan LB: Cardiac pumping capability and prognosis in heart failure. Lancet 1987; ii: 1360-1363.

  10. Bergel DH, Clark C, Schultz DL, Tunstall-Pedoe DS: The determination of the mechanical energy expenditure during ventricular pumping. J Physiol 1969; 204: 70-71P.

  11. Picard MH, Davidoff R, Sleeper L, Mendes LA, Thompson CR, Dzavik V, et al for the Shock Trial: Echocardiographic predictors of survival and response to early revascularization in cardiogenic shock. Circulation 2003; 107: 279-284.

  12. Hasdai D, Holmes DR, Califf RM, Thompson TD, Hochman JS, Pfisterer M, Topol EJ, Gusto –I Investigators: Cardiogenic shock complicating acute myocardial infarction: predictors of death. Am Heart J 1999; 138: 21-31.

  13. Tan LB, Littler WA: Measurement of cardiac reserve in cardiogenic shock: implications for prognosis and management. Br Heart J 1990; 64: 121-128.

  14. Cotter G, Williams SG, Vered Z, Tan LB: Role of cardiac power in heart failure. Curr Opin Cardiol 2003; 18: 215-222.

  15. Cotter G, Moshkovitz Y, Milovanov O, Salah A, Blatt A, Krakover R, et al: Acute congestive heart failure: A novel approach to its pathogenesis and treatment. Eur J Heart Fail 2002; 4: 227-234.

  16. Fincke R, Hochman JS, Lowe AM, Menon V, Slater JN, Webb JG, et al, for the SHOCK Investigators: Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock: A report from the SHOCK Trial Registry. J Am Coll Cardiol 2004; 44: 340-348.

  17. Lupi HE, Chuquiure EV, Cuellar B, Arias A, Pacheco HG, Martínez SC: El poder cardíaco un instrumento del pasado, una herramienta moderna en la valoración clínica-terapéutica y pronóstica del choque cardiogénico por síndrome isquémico coronario agudo. Arch Cardiol Mex 2006; 76: 95-108 .

  18. D´Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al: Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med 1991; 115: 343-349.

  19. Sandoval J, Baurle O, Palomar A, Gómez A, Martínez-Guerra ML, Beltrán M, et al: Survival in primary pulmonary hypertension: validation of a prognostic equation. Circulation 1994; 89: 1733-1744.

  20. Sitbon O, Humbert M, Nunes H, Parent F, García G, Hervé P, et al: Long-term intravenous epoprostenol infusion in primary pulmonary hypertension. Prognostic factors and survival. J Am Coll Cardiol 2002; 40: 780-788.

  21. Simmonneau G, Galié N, Rubin LJ, Langleben D, Seeger W, Domenighetti G, et al: Clinical classification of pulmonary hypertension. J Am Coll Cardiol 2004; 43: 5S-12S.

  22. Lupi HE, Bialostozky D, Sobrino A: The role of isoproterenol in pulmonary artery hypertension of unknown etiology [Primary]. Short- and long-term evaluation. Chest 1981; 79: 292-296.

  23. Lupi HE, Camacho B, Bialostozky D, Contreras M, Martínez-Guerra ML, Bonetti PF: Hipertensión arterial pulmonar de etiología desconocida. Estudio de la función cardiopulmonar. Arch Inst Cardiol Mex 1978; 48: 995-1110.

  24. Lupi HE, Bialostozky D: Respuesta cardiopulmonar al ejercicio en pacientes con hipertensión arterial pulmonar de etiología desconocida. Arch Inst Cardiol Mex 1979; 49: 969-983.

  25. Lupi HE, Sandoval J, Seoane M, Bialostozky D, Attie F: The role of isoproterenol in the preoperative evaluation of high-pressure, high-resistance ventricular septal defect. Chest 1982; 81: 42-46.

  26. Lupi HE, Sandoval J, Seoane M, Bialostozky D: The role of hydralazine therapy for pulmonary arterial hypertension of unknown cause. Circulation 1982; 65: 645-650.

  27. Lupi HE, Sandoval J, Seoane M, Bialostozky D: Behavior of the pulmonary circulation in chronic obstructive pulmonary disease. Pathogenesis of pulmonary arterial hypertension at an altitude of 2,240 meters. Am Rev Respir Dis 1982; 126: 509-514.

  28. Lupi HE, Sandoval J, Seoane M, Bialostozky D, Verdejo J: La función ventricular derecha en la neumopatía obstructiva crónica con cardiopatía pulmonar. Su estudio a la altura de la ciudad de México [2,240 metros]. Arch Inst Cardiol Méx 1981; 51: 535-540.

  29. Lupi HE, Seoane M, Sandoval J, Casanova JM, Bialostozky D: Behavior of the pulmonary circulation in the grossly obese patient. Pathogenesis of pulmonary arterial hypertension at an altitude of 2,240 meters. Chest 1980; 78: 553-558.

  30. Lupi HE, Sandoval J, Bialostozky D, Seoane M, Martínez-Guerra ML, Fernández BP, et al: Extrinsic allergic alveolitis caused by pigeon breeding at a high altitude [2,240 meters]. Hemodynamic behavior of pulmonary circulation. Am Rev Respir Dis 1981; 124: 602-607.

  31. Lupi HE, Sandoval JZ, Chuquiure VE, Carrillo A: El análisis del poder cardíaco "pulmonar" en hipertensión arterial pulmonar primaria y secundaria. Observaciones iniciales, su posible utilidad en la clínica. Arch Cardiol Méx 2006 ; 76: 140-50.

  32. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force on diagnosis and treatment of pulmonary arterial hypertension of the European Society of Cardiology. Eur Heart J 2004; 25: 2243-2278.

  33. Rich S, Dantzker DR, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al: Primary Pulmonary Hypertension. A National Prospective Study. Ann Intern Med 1987; 107: 216-223.

  34. Rich S, Levy PS: Characteristics of surviving and nonsurviving patients with primary pulmonary hypertension. Am J Med 1984; 76: 573-578.

  35. Chin KM, Kim NHS, Rubin LJ: The right ventricle in pulmonary hypertension. Coron Artery Dis 2005; 16: 13-18.

  36. Goldman L, Hashimoto B, Cook F, Loscalzo A: Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation 1981; 64: 1227-1234.

  37. Barst RJ, Rubin L, Long WA, McGoon MD, Rich S, Badesch DB, et al: A comparison of continuous intravenous epoprostenol [prostacyclin] with conventional therapy for primary pulmonary hypertension. N Engl J Med 1996; 334: 296-301.

  38. Olschewski H, Simonneau G, Galié N, Higenbottam T, Naeije R, Rubin L, et al: Inhaled Iloprost for severe pulmonary hypertension. N Engl J Med 2002; 347: 322-329 .

  39. Sitbon O, Humbert M, Ioos V, Jais X, Parent F, García P, et al: Who benefit from long-term calcium-channel blockers therapy in primary pulmonary hypertension? Am J Resp Crit Care Med 2003; 167: A440.

  40. Sitbon O, Brenot F, Denjean A, Bergeron A, Parent F, Azarian R, et al: Inhaled nitric oxide as a screening vasodilator agent in primary pulmonary hypertension. Am J Respir Crit Care Med 1995; 151: 384-389.

  41. Versprille A: Pulmonary vascular resistance. A meaningless variable. Intensive Care Med 1984; 10: 51-53.

  42. McGregor M, Sniderman A: On pulmonary vascular resistance: the need for a more precise definition. Am J Cardiol 1985; 55: 217-221.

  43. Naeije R: Pulmonary vascular resistance. A meaningless variable? Intensive Care Med 2003; 29: 526-529.

  44. Lupi HE, Yuriko-Furuya MME, Sandoval ZJ, Correa ME, Maxwel R, Seoane M: La conductancia vascular y la presión crítica de cierre en el lóbulo canino aislado in situ. Su historia natural. Arch Inst Cardiol Méx 1988; 58: 395-407.

  45. Rich S, Kaufmann E, Levy P: The effect of high doses of calcium-channel blockers on survival in primary pulmonary hypertension. N Engl J Med 1992; 327: 76-81.

  46. Beltrán GME, Sandoval ZJ, Seoane M, Lupi HE: Diez años de experiencia con el uso de vasodilatadores en tratamiento de la hipertensión arterial pulmonar primaria [1977-1987]. Arch Inst Cardiol Méx 1988; 58: 281-291.

  47. Weir EK, Rubin LJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al: The acute administration of vasodilators in primary pulmonary hypertension. Experience from the National Institutes of Health Registry on Primary Pulmonary Hypertension. Am Rev Respir Dis 1989; 140: 1623-1630.

  48. Rich S, Martínez J, Lam W, Levy PS, Rosen KM: Reassessment of the effects of vasodilator drugs in primary pulmonary hypertension: Guidelines for determining a pulmonary vasodilator response. Am Heart J 1983; 105: 119-127.

  49. Reeves JT, Groves BM, Turkevich D: The case for treatment of selected patients with primary pulmonary hypertension. Am Rev Respir Dis 1986; 134: 342-346.

  50. Palevsky HI, Schloo B, Pietra GG, Fishman AP: A potential new role for open lung biopsies in the evaluation of unexplained pulmonary hypertension. Am Rev Respir Dis 1985; 131: A 401.

  51. Hoeper MM, Oudiz RJ, Peacock A, Tapson VF, Haworth SG, Frost AE, Tobicki A: End points and clinical trial designs in pulmonary arterial hypertension. Clinical and regulatory perspectives. J Am Coll Cardiol 2004; 43: 48S-55S.




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