Table 1.
Development of a comprehensive nomenclature of right heart failure: framework, components, and issues
| Components, issues |
|---|
| 1. Etiology: What is the primary cause? |
| a. Draw upon existing classification systems for congenital heart disease |
| b. Advance current descriptions of acquired etiologies (The novel aspect lies in the expanded definition of right heart failure to include precardiac and postpulmonary valvular compartments.) |
| 2. Anatomy: Where is the primary defect? |
| a. Describe the anatomic constituents of the right heart circulatory system |
| b. Describe the anatomic defects within the right heart circulatory system (systemic circuit and pulmonary circuit) and left heart circulatory system |
| 3. Physiology: What is the primary aberration? |
| a. Define the appropriate hemodynamic and nonhemodynamic definitions and assessments of 3 distinct physiologic disturbances in the domains of preload stress, contractile insufficiency, and afterload stress |
| 4. Clinical function: What is the clinical expression in the patient? |
| a. Functional class components |
| A. Subjective component |
| a. Patient’s reported symptom (modified NYHA functional class) |
| b. Assessment of patient’s activity profile (sedentary, active, etc.) |
| c. Quality of life (most appropriate assessment to be determined) |
| B. Objective component |
| a. 6MWT (include Borg score, percent predicted value) |
| b. Pending results and/or clinical situation, proceed with cardiopulmonary stress test (CPEX) (availability, safety, and consistency in interpretation of data presenting as barriers to be further discussed) |
| i. Assess hemodynamic and/or ventilator response/insufficiency |
| C. Modifiers to functional assessment (noncardiovascular contributors to symptoms) |
| a. Body mass index (BMI) |
| b. Orthopedic limitations |
| c. Systemic processes |
| b. How should secondary modifiers (secondary organ function) be incorporated? |
| i. Renal dysfunction, as measured by GFR? |
| ii. Hepatic dysfunction, as measured by MELD (Should these elements be treated under physiologic aberrations or functional aspects?) |
Note
NYHA: New York Heart Association; 6MWT: 6-minute walk test; CPEX: cardiopulmonary exercise test; GFR: glomerular filtration rate; MELD: model for end-stage liver disease.