New York Heart Association functional class predicts exercise parameters in the current era

Stuart D. Russell, Matthew A. Saval, Jennifer L. Robbins, Myrvin H. Ellestad, Stephen S. Gottlieb, Eileen M. Handberg, Yi Zhou, Bleakley Chandler

Research output: Contribution to journalArticlepeer-review


Background: The New York Heart Association (NYHA) functional class is a subjective estimate of a patient's functional ability based on symptoms that do not always correlate with the objective estimate of functional capacity, peak oxygen consumption (peak Vo2). In addition, relationships between these 2 measurements have not been examined in the current medical era when patients are using β-blockers, aldosterone antagonists, and cardiac resynchronization therapy (CRT). Using baseline data from the HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) study, we examined this relationship. Methods: One thousand seven hundred fifty-eight patients underwent a symptom-limited metabolic stress test and stopped exercise due to dyspnea or fatigue. The relationship between NYHA functional class and peak Vo2 was examined. In addition, the effects of β-blockers, aldosterone antagonists, and CRT therapy on these relationships were compared. Results: The NYHA II patients have a significantly higher peak Vo2 (16.1 ± 4.6 vs 13.0 ± 4.2 mL/kg per minute), a lower ventilation (Ve)/Vco2 slope (32.8 ± 7.7 vs 36.8 ± 10.4), and a longer duration of exercise (11.0 ± 3.9 vs 8.0 ± 3.4 minutes) than NYHA III/IV patients. Within each functional class, there was no difference in any of the exercise parameters between patients on or off of β-blockers, aldosterone antagonists, or CRT therapy. Finally, with increasing age, a significant difference in peak Vo2, Ve/Vco2 slope, and exercise time was found. Conclusion: For patients being treated with current medical therapy, there still is a difference in true functional capacity between NYHA functional class II and III/IV patients. However, within each NYHA functional class, the presence or absence or contemporary heart failure therapies does not alter exercise parameters.

Original languageEnglish (US)
Pages (from-to)S24-S30
JournalAmerican heart journal
Issue number4 SUPPL.
StatePublished - Oct 2009

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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