Comparison of different methods of functional evaluation in patients with chronic heart failure

Background: Stratification of the severity of heart failure has major progn ostic and therapeutic implications. Aims: To prospectively compare differen t methods of assessment of functional capacity in patients with chronic hea rt failure (CHF). Methods and results: We studied 143 patients (78 male and 65 female) with CHF aged less than 70 years (mean 57.3 years). Functional assessment was made clinically according to NYHA classification and accordi ng to the Goldman Activity Scale Classification (GASC). Cardiovascular perf ormance was measured by peak O-2 consumption (pVO(2)) and anaerobic thresho ld (AT) at cardiopulmonary exercise test and by the: distance walked during a 6-min walk test (6-MWT). Clinical scales resulted significantly related. Peak VO2 and AT showed a mild relation with distance covered at 6-MWT (r = 0.56 and r = 0.46, respectively). Concordance between NYHA classification and levels of performance at cardiopulmonary exercise test or at 6-MWT was less than 50%. Conclusion: Our results suggest that none of the usually emp loyed methods give a definitive assessment of functional capacity of cardio vascular system and a high degree of discordance exists among the results o f different tests in the same patient. Although NYHA classification maintai ns its value in clinical evaluation of patients with CHF, the 6-min walk te st is recommended in patients with mild-to-moderate CHF (II-III NYHA classe s) as a simple and useful screening test to select patients for further dia gnostic evaluation. (C) 2000 European Society of Cardiology. All rights res erved.