Is the Ability index superior to the NYHA classification for assessing heart failure?: comparison of two classification scales in adolescents and adults with operated congenital heart defects.
BACKGROUND
Heart failure (HF) is a major problem in the long-term follow-up of adolescents and adults with congenital heart disease (ACHD) after cardiac surgery. The functional status of ACHD may be assessed in terms of the NYHA classification or the Ability index (ABILITY).


OBJECTIVE
The purpose of our study was to examine which of the two classification systems is more closely related to objectively defined HF.


METHODS
NT-pro brain natriuretic peptide (N-BNP) and maximal oxygen uptake (VO(2max)) were measured in 360 consecutive ACHD patients. HF was defined as an elevated N-BNP level > or =100 pg/ml combined with a reduced VO(2max) < or =25 ml/kg/min.


RESULTS
There were no significant differences between the NYHA and ABILITY in grading HF in these patients. In both classifications, the risk of HF increases continuously over the classes and grades from odds ratio (OR) 1 in NYHA I/ABILITY 1 to an OR=3.4 in NYHA II/ ABILITY 2 up to 11.6 or 5.4 (ns) in NYHA III/ABILITY 3. Thus in the highest scores HF is found in 70-77% of the patients. The fact that in NYHA class I and ABILITY grade 1, 15% and 19% of the patients exhibited HF according to the measured indices underscores the discrepancy between subjective and objective assessment of the individual patients condition.


CONCLUSIONS
The NYHA classification and the Ability index take different approaches to the patients with congenital heart defects but are equally suitable for the judgement of HF in post surgical ACHD.
Norozi
Kambiz
K
Department of Paediatric Cardiology and Intensive Care Medicine, Medical School Hannover, OE 6730, Carl-Neuberg-Str. 1, 30623, Hannover, Germany. Norozi.kambiz@mh-hannover.de
Wessel
Armin
A
Buchhorn
Reiner
R
Alpers
Valentin
V
Arnhold
Jan O
JO
Zoege
Monika
M
Geyer
Siegfried
S
D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000150:complications* / Q000601:surgery; D006333:Heart Failure / Q000145:classification* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D016017:Odds Ratio; D010101:Oxygen Consumption / Q000502:physiology; D010446:Peptide Fragments / Q000378:metabolism; D011237:Predictive Value of Tests; D018570:Risk Assessment / Q000379:methods; D012720:Severity of Illness Index
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain