TNM-like classification: a new proposed method for heart failure staging

Abstract

Heart Failure (HF) is an acute or chronic syndrome, that causes a lot of damaging effects to every system. The involvement of different systems is variably related to age and others comorbidities. The severity of organ damage is often proportional to the duration of heart failure. The typology of HF and the duration determine which organs will be affected and vice versa the severity of organ damage supplies precious information about prognosis and outcome of patients with heart failure. Moreover, a classification based not only on symptomatic and syndromic typical features of heart failure, but also on functional data of each system, could allow us to apply the most appropriate therapies, to obtain a more accurate prognosis, and to employ necessary and not redundant human and financial resources. With an eye on the TNM staging used in oncology, we drawn up a classification that will consider the different involvement of organs such as lungs, kidneys, and liver in addition to psychological pattern and quality of life in HF patients. For all these reasons, it is our intention to propose a valid and more specific classification available for the clinical staging of HF that takes into account pathophysiological and structural changes that can remark prognosis and management of HF.

Figure 1

Physiopathology and reference range values in precapillary pulmonary hypertension and postcapillary pulmonary hypertension.

Figure 2

The concept of cardiorenal syndrome that often brings the insaturation of a vicious circle is graphically explicated. SCr: Serum Creatinine; ClCr: Clearance of Creatinine; Cys-C: Cystatine-C.

Figure 3

Shows the way of liver's impairment in HF. ALT: Alanine Transaminase; ALP: Alkaline Phosphatase; INR: International Normalized Ratio.