TITLE

Correlación clínica-hemodinámica de la clasificación de la NYHA/WHO en enfermos con hipertensión arterial pulmonar idiopática. Sus implicaciones en la clínica, en el tratamiento y en el pronó

AUTHOR(S)
Herrera, Eulo Lupi; Zárate, Julio Sandoval; Solano, Javier Figueroa; Santos Martínez, Luis Efrén; Pulido Zamudio, Tomás René; Bautista Bautista, Edgar Gildardo
PUB. DATE
April 2008
SOURCE
Archivos de Cardiología de México;abr-jun2008, Vol. 78 Issue 2, p148
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
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 [IPAH], 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 IPAH 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 IPAH 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 longterm survival; irrespective of the treatment the prognosis seems to be excellent for this functional class group patients.
ACCESSION #
34070763

 

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