[Problems of clinical evaluation of hemodynamics at rest and during exercise in chronic heart disease. Value of cardiac catheterization and problems of clinical classification].
BACKGROUND
NYHA classification is mostly used for graduation of clinical limitation due to cardiac failure. Right heart catheterization is not generally used to evaluate hemodynamics and to define the effects of drugs in patients with chronic cardiac failure. Clinical data and results from echocardiography, stress tests or nuclear cardiology seem to be sufficient. Our aim was to demonstrate subjectivity of a classification system (NYHA) comparing the graduation done by physicians and by patients and to represent the difficulty to prognosticate hemodynamic data of patients with heart failure.


METHODS
Limitation of 53 patients with heart diseases was classified by physicians and patients using NYHA classification. Pulmonary capillary wedge pressure (PCWP), stroke volume (SV) and cardiac output were predicted by physicians; they were allowed to utilize all examination data they could get. Predicted hemodynamic data were compared with the results of measurement at rest and during exercise.


RESULTS
Patients classified themselves significantly worse than physicians did: 2.68 +/- 0.64 vs. 2.23 +/- 0.74 (p = 0.0012). Similarity in NYHA classification was found in 29/53 cases. Correlation of predicted and measured hemodynamic data was low: PCWP (at rest) r = 0.346; PCWP (during exercise) r = 0.232; SV (at rest) r = 0.476; SV (during exercise) r = 0.445; HMV (at rest) r = 0.412; HMV (during exercise) r = 0.538.


CONCLUSIONS
Clinical classification systems like NYHA are subjective, classification by physicians differs significantly from classification by patients. Prediction of hemodynamics is not possible despite all examination data had been available. Right heart catheterization is necessary to define hemodynamics at rest and during exercise.
Jäger
D
D
Medizinische Klinik II, Kardiologie, Städtisches Krankenhaus Friedrichshafen.
Baberg
H T
HT
Machraoui
A
A
Barmeyer
J
J
D006328:Cardiac Catheterization / Q000379:methods; D003937:Diagnosis, Differential; D005080:Exercise Test; D006331:Heart Diseases / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D006439:Hemodynamics; D006801:Humans; D015588:Observer Variation; D011379:Prognosis; D012647:Self-Assessment; D012720:Severity of Illness Index