In hospitalized acute heart failure 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 and NYHA class at admission did not significantly predict the 180-day composite outcome of readmission or all-cause mortality.
Higher NYHA class at admission was associated with older age and greater comorbidity burden in patients with acute heart failure.
Higher NYHA class at admission was associated with lower left ventricular ejection fraction and impaired global longitudinal strain.
Higher NYHA class at admission was associated with higher E/e' ratio and greater B-line count on lung ultrasound.
At follow-up 1–3 months post-discharge, left ventricular systolic function, B-line count, and left atrial size parameters were similar across baseline NYHA classes.
Atrial functional parameters remained lower with increasing NYHA class at admission even at follow-up.
NYHA class at admission was not associated with the 180-day composite outcome of AHF readmission or all-cause mortality.
This research studied 564 patients hospitalized with acute heart failure at two centers between 2022 and 2024. The researchers used echocardiography (heart ultrasound), lung ultrasound, and blood biomarkers to objectively measure how sick each patient was, and they compared these measurements across different levels of the New York Heart Association (NYHA) classification system — a standard way doctors rate how severe a patient's heart failure symptoms are, ranging from mild (class I/II) to severe (class IV). Half of the patients were classified as the most severe category (NYHA class IV), and the study found that patients with higher NYHA classes did indeed show worse heart function, more fluid in the lungs, and more other medical conditions at the time of admission. However, when patients were re-examined 1–3 months after leaving the hospital, most of these differences between NYHA groups had largely disappeared — heart pumping function, lung congestion, and heart chamber size looked similar regardless of what NYHA class a patient had been assigned at admission. One exception was atrial (upper heart chamber) function, which remained worse in patients who had been classified as more severe at admission, suggesting this may be a more lasting marker of heart failure severity. Importantly, the NYHA class assigned at hospital admission did not predict which patients were more likely to be readmitted or die within 180 days. This research suggests that while higher NYHA class at admission is associated with objectively worse heart and lung measurements, it may not be a reliable tool for predicting which hospitalized heart failure patients will have worse long-term outcomes. The resolution of most objective differences at follow-up also raises questions about the long-term significance of NYHA class assigned during an acute illness, and highlights the potential importance of atrial function as a marker that persists beyond the acute episode.
Al-Rubai A, Davidovski F, Espersen C, Stanchev A, Adam L, Khoraizat A, et al.. (2026). Cardiac Structure and Function and Pulmonary Congestion Across New York Heart Association Classes in Patients With Acute Heart Failure.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70634