[Clinical-hemodynamic correlation of the NYHA/WHO system in idiopathic pulmonary artery hypertension. Clinical, therapeutic and long-term prognosis implications].
BACKGROUND
The most often used functional classification for categorizing the degree of cardiac disability in patients with chronic left ventricular failure is the NYHAN/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.
Herrera
Eulo Lupi
EL
Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, México, DF.
Zárate
Julio Sandoval
JS
Solano
Javier Figueroa
JF
Martínez
Luis Efrén Santos
LE
Zamudio
Tomás René Pulido
TR
Bautista
Edgar Gildardo Bautista
EG