Relationship between functional class and left ventricular ejection fraction in patients with coronary heart disease who were candidates for cardiac rehabilitation

Isabella Martins de Albuquerque, Andrieli Barbieri Garlet, Dannuey Machado Cardoso, Tamires Daros Santos, Sérgio Nunes Pereira

Abstract


***Relationship between functional class and left ventricular ejection fraction in patients with coronary heart disease who were candidates for cardiac rehabilitation***

AIMS: To assess the potential relation between the New York Heart Association functional class and left ventricular ejection fraction in coronary heart disease patients who were candidates for cardiac rehabilitation.

METHODS: This is a retrospective cross-sectional study based on the analysis of medical records of coronary heart disease patients who were candidates for the Cardiac Rehabilitation Program of Hospital Universitário de Santa Maria, state of Rio Grande do Sul, Brazil. Both male and female patients aged 50 to 65 were included, whereas patients with chronic renal failure, anemia, poor echocardiographic image quality, non-sinus rhythm, and also those individuals whose medical records lacked sufficient information were excluded. Data were collected from August 2015 to March 2016, and the information that made up the variables of interest was extracted from the medical records, such as: clinical and demographic data (sex, age, comorbidities, clinical diagnosis, surgical and drug treatment), left ventricular ejection fraction values obtained by echocardiography (conventional and tissue Doppler echocardiography), and functional class from the ergometric test. Statistical analysis was performed using Kruskal-Wallis test followed by Dunn’s post-hoc test.  The significance level was set at p<0.05.

RESULTS: A total of 131 medical records were consecutively evaluated, of which 102 met the inclusion criteria. Mean age was 59.23±7.95 years and 70 (68.63%) patients were male, with a predominance of functional class I. There was an inverse relation between functional class and ejection fraction: the more advanced the functional class, the more compromised the cardiac performance (p=0.036).

CONCLUSIONS: In this sample of patients with coronary heart disease who were candidates for cardiac rehabilitation, there was an inverse relation between left ventricular ejection fraction and functional class. This finding provides information about the limitations imposed by the disease on patient’s exercise capacity and heart function and can contribute to the development of a physical training program.


Keywords


coronary heart disease; myocardial revascularization; angioplasty; rehabilitation.

References


Brasil. Ministério da Saúde, Pesquisa Nacional de Saúde 2013. Percepção do estado de saúde, estilos de vida e doenças crônicas [Internet]. Rio de Janeiro; 2013 [cited 2016 September]. Available from: http://biblioteca.ibge.gov.br/visualizacao/livros/liv91110.pdf

World Health Organization (WHO). Cardiovascular diseases (CVDS) [Internet]. 2016 [cited 2016 September]. Available from: http://www.who.int/mediacentre/factsheets/fs317/en/

Werf FV, Bax J, Betriu A, Blomstrom-Lundgvist C, Crea F, Falk V. Management of acute myocardial infarction in patients presenting with persistent ST – segment elevation: the Task Force on the Management of ST – Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29(23):2909-45. https://doi.org/10.1093/eurheartj/ehn416

Lear SJ, Spinelli JJ, Linden W, Brozic A, Kiess M, Frohlich JJ, Ignaszewski A. The extensive lifestyle management intervention (ELMI) after cardiac rehabilitation: a 4- year randomized controlled trial. J Am Heart Assoc. 2006;152(2):333-9. https://doi.org/10.1016/j.ahj.2005.12.023

Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, Thompson PD, Williams MA, Lauer MS. Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease. An American Heart Association Scientific Statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in Collaboration with the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005;111(3):369-76. https://doi.org/10.1161/01.CIR.0000151788.08740.5C

McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A; Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Bonet LA, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Flachskampf FA, Guida GF, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Orn S, Parissis JT, Ponikowski P; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):803-69. https://doi.org/10.1093/eurjhf/hfs105

Silva JC, Rochitte CE, Júnior JS, Tsutsui J, Andrade J, Martinez EE, Moffa PJ, Menegheti JC, Kalil-Filho R, Ramires JF, Nicolau JC. Late coronary artery recanalization effects on left ventricular remodelling and contractility by magnetic resonance imaging. Eur Heart J. 2005;26:36-43. https://doi.org/10.1093/eurheartj/ehi011

O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso JE, Tracy CM, Woo YJ, Zhao DX; CF/AHA Task Force. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Jan 29;127(4):529-55. https://doi.org/10.1161/CIR.0b013e3182742c84

Herdy AH, López-Jimenez F, Terzic CP, Milani M, Stein R, Carvalho T; Sociedade Brasileira de Cardiologia. Diretriz Sul-Americana de Prevenção e Reabilitação Cardiovascular. Arq Bras Cardiol 2014;103(2):1-31. https://doi.org/10.5935/abc.2014S003

Godoy-Matos AF, Oliveira J, Guedes EP, Carraro L, Lopes AC, Mancini MC. Diretrizes Brasileiras de Obesidade. Associação Brasileira para o Estudo da Obesidade e Síndrome Metabólica. 2009/2010; 3ª ed. São Paulo; 2009.

Mann DL, Ziper DP, Libby P, Bonow RO, BraunwaldE. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. Philadelphia: Saunders; 2015.

American Heart Association. Ejection fraction heart failure measurement [Internet]. [cited 2015 June]. Available from: http://www.heart.org/HEARTORG/Conditions/HeartFailure/DiagnosingHeartFailure/Ejection-Fraction-Heart-Failure-Measurement_UCM_306339_Article.jsp#.V1i2pLsrLIU

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016 Aug;18(8):891-975. https://doi.org/10.1002/ejhf.592

Mady C, Salemi VMC, Ianni BM, Ramires FJA, Arteaga E. Capacidade funcional máxima, fração de ejeção e classe funcional na cardiomiopatia chagásica. Existe relação entre estes índices? Arq Bras Cardiol. 2005;84(2):152-5. https://doi.org/10.1590/S0066-782X2005000200011

Bocchi EA, Marcondes-Braga FG, Ayub-Ferreira SM, Rohde LE, Oliveira WA, Almeida DR, Moreira MCV, Bestetti RB, Bordignon S, Azevedo C, Tinoco EM, Rocha RM, Issa VS, Ferraz A, Cruz FD, Guimarães GV, Montera VSP, Albuquerque DC, Bacall F, Souza GEC, Neto JMR, Clausell NO, Martins SM, Siciliano A, Neto JDS, Moreira LF, Teixeira RA, Moura LZ, Beck-da-Silva L, Rassi S, Azeka E, Horowitz E, Ramires F, Simões MV, Castro RBP, Salemi VMC, Junior HV, Vila JH, Simões R, Albanesi F, Montera MW. Sociedade Brasileira de Cardiologia. III Diretriz Brasileira de Insuficiência Cardíaca Crônica. Arq Bras Cardiol. 2009;93(1 supl.1):1-71.

Bennett JA, Riegel B, Bittner V, Nichols J. Validity and reliability of the NYHA classes for measuring research outcomes in patients with cardiac disease. Heart Lung. 2002;31(4):262-70. https://doi.org/10.1067/mhl.2002.124554

Hunt SM, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al. ACC/AHA Guidelines for Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary a Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). Circulation. 2001;104(24):2296-3007. https://doi.org/10.1161/hc4901.102568

Pereira DAG, Rodrigues RS, Samora GAR, Lage SM, Alencar MCN, Perreira VF, Britto RR. Capacidade funcional de indivíduos com insuficiência cardíaca avaliada pelo teste de esforço cardiopulmonar e classificação da New York Heart Association. Fisioter Pesqui. 2012;19(1):52-6. https://doi.org/10.1590/S1809-29502012000100010

Herrera EL, Zárate JS, Solano JF, Martínez LES, Zamudio TRP, Bautista EGB. 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 pronóstico a largo plazo. Arch Cardiol Méx. 2008;78(2):148-161.

Santos AAS, Silva AKF, Vanderlei FM, Christofaro DGD, Gonçalves AFL, Vanderlei LCM. Analysis of agreement between cardiac risk stratification protocols applied to participants of a center for cardiac rehabilitation. Braz J Phys Ther. 2016;20(4):298-305. https://doi.org/10.1590/bjpt-rbf.2014.0159

American Association of cardiovascular and Pulmonary Rehabilitation. Diretrizes para reabilitação cardíaca e programas de prevenção secundária. 4ª ed. São Paulo: Roca; 2007.

Parmley WW. Position report on cardiac rehabilitation. Recommendations of the American College of Cardiology. J Am Coll Cardiol. 1986;7(2):451-3. https://doi.org/10.1016/S0735-1097(86)80526-5

Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, Frorlicher VF, Leon AS, Pi-a L, Rodney R, Simons-Morton DA, Williams MA, Bazzarre T. Exercise Standards for Testing and Training: A Statement for Healthcare Professionals from the American Heart Association. Circulation. 2001;104(14):1694-740. https://doi.org/10.1161/hc3901.095960

Audelin MC, Savage PD, Ades PA. Changing clinical profile of patients entering cardiac rehabilitation/secondary prevention programs: 1996 to 2006. J Cardiopulm Rehabil Prev. 2008;28(5):299-306. https://doi.org/10.1097/01.HCR.0000336139.48698.26

Gomadam PS, Douglas CJ, Sacrinty MT, Brady MM, Paladenech CC, Robinson KC. Degree and direction of change of body weight in cardiac rehabilitation and impact on exercise capacity and cardiac risk factors. Am J Cardiol. 2016;117(4):580-4.

https://doi.org/10.1016/j.amjcard.2015.11.045

Ades PA, Savage PD, Harvey-Berino J. The Treatment of Obesity in Cardiac Rehabilitation. Journal of cardiopulmonary rehabilitation and prevention. 2010;30(5):289-98. https://doi.org/10.1097/HCR.0b013e3181d6f9a8




DOI: http://dx.doi.org/10.15448/1980-6108.2017.3.26652

 

***************************************************************************************************************

From 2011 (when it was indexed in Scopus), Scientia Medica features the Scimago Journal & Country Rank (SJR) impact factor.

SCImago Journal & Country Rank



 This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE) http://www.publicationethics.org

 

Licença Creative Commons
Except where otherwise noted, content of this journal is licensed under a Creative Commons Attribution 4.0 International license.


Editorial Policies of Brazilian Scientific Journals. Deposit availability: Blue .

Copyright: © 2006-2017 EDIPUCRS