Prediction of hemodynamics at rest and during exercise in patients with chronic heart diseases

Background: NYHA classification is mostly used for graduation of clinical l imitation due to cardiac failure. Right heart catheterization is not genera lly used to evaluate hemodynamics and to define the effects of drugs in pat ients with chronic cardiac failure. Clinical data and results from echocard iography. stress tests or nuclear cardiology seem to be sufficient. Our aim was to demonstrate subjectivity of a classification system (NYHA) comparin g the graduation done by physicians and by patients and to represent the di fficulty to prognosticate hemodynamic data of patients with heart failure. Patients and Methods: Limitation of 53 patients with heart diseases was cla ssified by physicians and patients using NYHA classification. Pulmonary cap illary wedge pressure (PCWP), stroke volume (SV) and cardiac output were pr edicted by physicians; they were allowed to utilize all examination data th ey 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 clas sification was found in 29/53 eases. 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. Conclusion: Clinical classification systems like NYHA are subjective, class ification by physicians differs significantly from classification by patien ts. Prediction of hemodynamics is not possible despite all examination data had been available. Right heart catheterization is necessary to define hem odynamics at rest and during exercise.