Key result
Higher NYHA class at admission was associated with worse cardiac dysfunction and pulmonary congestion, but did not significantly predict the 180-day composite outcome of mortality or readmission (HR 1.40 for NYHA IV vs I/II, 95% CI 0.95-2.06, p=0.09).
Why the study?
The relationship between NYHA classification and objective markers such as echocardiography, lung ultrasound, and biomarkers in acute heart failure remains unclear.
Does NYHA class at admission predict 180-day outcomes or correlate with echocardiographic and lung ultrasound markers in patients hospitalized with acute heart failure?
Cohort (n=564)
Yes
Does NYHA class at admission predict 180-day outcomes or correlate with echocardiographic and lung ultrasound markers in patients hospitalized with acute heart failure?
Hazard Ratio: 1.4 (95% CI 0.95–2.06)
p-value: p=0.09
While NYHA class at admission in acute heart failure correlates with objective baseline echocardiographic and lung ultrasound abnormalities, it does not reliably predict 180-day mortality or rehospitalization risk, suggesting limited standalone prognostic utility.
NYHA class should not guide 180-day risk stratification in acute HF; leaves open whether imaging markers add independent prognostic value.
BACKGROUND: Acute heart failure (AHF) is a major global health challenge, yet the relationship between New York Heart Association (NYHA) classification and objective markers such as echocardiography, lung ultrasound (LUS), and biomarkers remains unclear. METHODS: In this prospective two-center study, patients admitted with AHF (2022-2024) underwent echocardiography, 8-zone LUS, ECG, and biomarker sampling. Patients were stratified by NYHA class at enrollment, and associations with clinical, echocardiographic, and LUS measures were analyzed. Participants were invited for an identical follow-up examination 1-3 months post-discharge. The main outcome was a 180-day composite of AHF readmission or all-cause mortality evaluated across NYHA classes. RESULTS: Among 564 patients (mean age 78.2 years; 56.3% male), 23% were classified as NYHA class I/II, 27% as NYHA class III, and 50% as NYHA class IV. Higher NYHA class at admission was associated with older age, greater comorbidity burden, lower left ventricular ejection fraction, impaired global longitudinal strain, higher E/e' ratio, and B-line count (all p <0.05). At follow-up (n = 160), left ventricular systolic function, B-line count, and left atrial size parameters were similar across baseline NYHA class. Atrial functional parameters (peak atrial longitudinal and contraction strain) remained lower with increasing NYHA class at admission (both p <0.05). NYHA class at admission was not associated with the 180-days outcome. CONCLUSION: In this prospective study of hospitalized AHF patients, higher NYHA class at admission was associated with greater cardiac dysfunction, B-line burden, and comorbidity burden, but these differences largely resolved at follow-up. NYHA class at admission did not significantly predict the composite outcome.
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Al‐Rubai et al. (2026) conducted a cohort in Acute heart failure (AHF) (n=564). Higher NYHA class (III or IV) at admission vs. NYHA class I/II at admission was evaluated on Composite of AHF readmission or all-cause mortality within 180 days (HR 1.40, 95% CI 0.95-2.06, p=0.09). Higher NYHA class at admission was associated with worse cardiac dysfunction and pulmonary congestion, but did not significantly predict the 180-day composite outcome of mortality or readmission (HR 1.40 for NYHA IV vs I/II, 95% CI 0.95-2.06, p=0.09).
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