A. Gavotto , P. Amedro , I. Ouhab , S. Guillaumont , I. Liard , H. Huguet , M.C. Picot
{"title":"Which classification best predicts functional prognosis in children with congenital heart disease?","authors":"A. Gavotto , P. Amedro , I. Ouhab , S. Guillaumont , I. Liard , H. Huguet , M.C. Picot","doi":"10.1016/j.acvd.2024.07.010","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><p>Despite these advances in paediatric cardiology, the stratification of CHD severity using a simple and reproducible classification has not been established, as can be the NYHA functional class in adult heart failure. Various CHD classifications have been used in CHD, focusing on anatomical lesions, complexity of care, or physiological status, but their prognostic value has not been determined.</p></div><div><h3>Objective</h3><p>We aimed to compare the accuracy of the main existing CHD classifications (Uzark, Stout and Bethesda classifications), in the prediction of functional status in children with CHD, as determined by cardiopulmonary fitness.</p></div><div><h3>Methods</h3><p>Longitudinal cohort study.</p></div><div><h3>Results</h3><p>The CHD population having had 2 CPET included 296 subjects (<em>n</em> <!-->=<!--> <!-->129 female). The time between the first (T1) and second CPET (T2) assessments was 4.1<!--> <!-->±<!--> <!-->1.6<!--> <!-->years. The performance of classifications according to VO<sub>2</sub>max at T1 was better for Uzark classification. The VO<sub>2</sub>max Z-score decreased significantly according to the severity group (groups 1 and 2<!--> <!-->><!--> <!-->group 3<!--> <!-->><!--> <!-->group 4) and group 4 had a significant VO<sub>2</sub>max decrease of −6.68 [−10.69; −2.67] mL/kg/min compared to group 1. The prediction of classifications at T2 according to VO<sub>2</sub>max was better for Uzark classification with AUC values of 0.62 [0.55–0.69], compared to 0.59 [0.51–0.66] for Stout and 0.55 [0.48–0.62] for Bethesda (<span><span>Fig. 1</span></span>).</p></div><div><h3>Conclusion</h3><p>Among the existing cardiovascular risk classifications for CHD, the Uzark classification appeared to be the most reliable for discriminating the severity of CHD according to exercise capacity and for predicting the VO<sub>2</sub>max impairment than the other classifications tested. This longitudinal study also showed the continued decline in exercise capacity, whatever the CHD, and recalls the interest of regular monitoring to offer care adapted to these patients (such as rehabilitation programs) for primary prevention of the added cardiovascular risks of adulthood.</p></div>","PeriodicalId":55472,"journal":{"name":"Archives of Cardiovascular Diseases","volume":null,"pages":null},"PeriodicalIF":2.3000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Cardiovascular Diseases","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1875213624002316","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction
Despite these advances in paediatric cardiology, the stratification of CHD severity using a simple and reproducible classification has not been established, as can be the NYHA functional class in adult heart failure. Various CHD classifications have been used in CHD, focusing on anatomical lesions, complexity of care, or physiological status, but their prognostic value has not been determined.
Objective
We aimed to compare the accuracy of the main existing CHD classifications (Uzark, Stout and Bethesda classifications), in the prediction of functional status in children with CHD, as determined by cardiopulmonary fitness.
Methods
Longitudinal cohort study.
Results
The CHD population having had 2 CPET included 296 subjects (n = 129 female). The time between the first (T1) and second CPET (T2) assessments was 4.1 ± 1.6 years. The performance of classifications according to VO2max at T1 was better for Uzark classification. The VO2max Z-score decreased significantly according to the severity group (groups 1 and 2 > group 3 > group 4) and group 4 had a significant VO2max decrease of −6.68 [−10.69; −2.67] mL/kg/min compared to group 1. The prediction of classifications at T2 according to VO2max was better for Uzark classification with AUC values of 0.62 [0.55–0.69], compared to 0.59 [0.51–0.66] for Stout and 0.55 [0.48–0.62] for Bethesda (Fig. 1).
Conclusion
Among the existing cardiovascular risk classifications for CHD, the Uzark classification appeared to be the most reliable for discriminating the severity of CHD according to exercise capacity and for predicting the VO2max impairment than the other classifications tested. This longitudinal study also showed the continued decline in exercise capacity, whatever the CHD, and recalls the interest of regular monitoring to offer care adapted to these patients (such as rehabilitation programs) for primary prevention of the added cardiovascular risks of adulthood.
期刊介绍：
The Journal publishes original peer-reviewed clinical and research articles, epidemiological studies, new methodological clinical approaches, review articles and editorials. Topics covered include coronary artery and valve diseases, interventional and pediatric cardiology, cardiovascular surgery, cardiomyopathy and heart failure, arrhythmias and stimulation, cardiovascular imaging, vascular medicine and hypertension, epidemiology and risk factors, and large multicenter studies. Archives of Cardiovascular Diseases also publishes abstracts of papers presented at the annual sessions of the Journées Européennes de la Société Française de Cardiologie and the guidelines edited by the French Society of Cardiology.
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