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

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 [i-pah], 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 i-pah 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 [cl 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 l-ll did not represent the minority of i-pah 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 l-ll from iii-iv. i-pah patients class i have 12.6 times more the probability to be a responder and better long-term survival; irrespective of the treatment the prognosis seems to be excellent for this functional class group patients.