Russian Classification of Congestive Heart Failure
Two mutually complementary classifications of congestive heart failure (CHF) are used in Russia. The Strazhesko-Vasilenko system of staging the disease progression, adopted at the XII All-Union Convention of Internal Medicine Physicians in 1935 (Table 1) (3), and the New York Heart Association Functional Classification (NYHA FC) developed in 1964 (Table 2) (1).
The Strazhesko-Vasilenko classification describes morphological changes in the heart, hemodynamic properties, as well as the functional stages of heart failure progression. Although this classification is convenient for biventricular CHF, it cannot be used for the assessment of isolated left- or right-ventricular heart failure.
The NYHA classification relies on the severity of symptoms and the ability to function. It does not elaborate on structural or hemodynamic changes. It provides a simple and convenient patient evaluation tool for use in clinical practice.
Together, Strazhesko-Vasilenko and NYHA classifications provide a better clinical and objective evaluation of a patient with CHF than each system alone.
Strazhesko-Vasilenko Classification of Congestive Heart Failure
Clinical and Morphological Characteristics
|Stage I (initial)||Hemodynamic changes are absent at rest and are manifested only during exercise.|
|Period A (Stage IA)||Preclinical CHF. Complaints are nearly absent. Mild asymptomatic decrease of the ejection fraction (EF) and increase of the left ventricular end-diastolic volume (LVEDV) are detected during physical exercise.|
|Latent CHF. Symptoms are present only during physical exertion — dyspnea, tachycardia, and rapid development of fatigue. The clinical presentations disappear and hemodynamics normalize at rest.|
|Stage II||Hemodynamic compromise in the form of pulmonary and/or systemic congestion at rest.|
|Manifestations of CHF at rest are moderate. Hemodynamics are compromised only in one side of the cardiovascular system (pulmonary or systemic circulation).|
|Completion of the long progressive stage of CHF. Pronounced hemodynamic compromise, which involves the entire cardiovascular system (both pulmonary and systemic circuits).|
|Stage III||Pronounced hemodynamic disturbances and signs of venous congestion in both circulatory pathways. Significant perfusion defects and metabolic impairments of organs and tissues.|
|Pronounced signs of severe biventricular failure with congestion in both circulatory pathways (from peripheral edema to anasarca, hydrothorax, ascites etc.). Agressive complex treatment can eliminate congestion, stabilize hemodynamics, and partially restore the function of the vital organs.|
|End-stage CHF with severe diffuse hemodynamic disturbances, persistent decline in metabolism, and irreversible structural and functional degeneration of organs and tissues.|
New York Heart Association Functional Classification
|I||No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea (shortness of breath).|
|II||Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, or dyspnea (shortness of breath).|
|III||Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.|
|IV||Unable to endure any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.|
Although, the Russian classification of CHF progression uses the term “Stages,” and bears similarities with the American College of Cardiology/American Heart Association (ACC/AHA) Practice Guidelines (2) (please see Table1 and Table 3 for comparison), the two staging systems are not exactly the same. Thus, the term “Strazhesko-Vasilenko” is proposed.
American College of Cardiology/American Heart Association (ACC/AHA) Practice Guidelines*
|Stage A||Patients at high risk for developing HF in the future but no functional or structural heart disorder.|
|Stage B||A structural heart disorder but no symptoms at any stage.|
|Stage C||Previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.|
|Stage D||Advanced disease requiring hospital-based support, a heart transplant or palliative care.|
* ACC/AHA Practice Guidelines are typically not used in Russia. They are provided for the purpose of comparison with Strazhesko-Vasilenko Classification.
The purpose of this article is to shed light on the existing CHF classification systems in Russia and to attempt to standardize translated medical documentation on the subject.
Some medical documents translated from Russian to English render Strazhesko-Vasilenko stages as NK stages, circulatory insufficiency classes, cardiac insufficiency stages and so on. Some translations attempt to separate letters from the Roman numerals suggesting that letters represent stages and Roman numerals represent NYHA functional classes. (For example, Stage A Class III (NYHA) instead of Strazhesko-Vasilenko Stage IIIA). Such ambiguous translations present challenge to the reader and, in some cases, misinformation.
The abbreviation NK is a Romanization of the Russian nedostatochnoct krovoobrashenia that is sometimes translated literally as “circulatory insufficiency.” The Strazhesko-Vasilenko clinical and morphological classification, however, pertains to heart failure (3, 4): serdechnaya nedostatochnost ICD-10 class I50 in Russian (6) and the corresponding ICD-10 class in English (5).
1.^ American Heart Association. Classes of Heart Failure. [Internet]. 2017 [cited 2018 Mar 16]. Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp
2.^ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). American College of Cardiology Web Site. Available at: http://www.acc.org/clinical/guidelines/failure//index.pdf.
3.^ Mediko-sotsialnaya ekspertiza [Social and Medical Expert Evaluation]. Klassificatsia khronicheskoy serdechnoy nedostatochnosti [Classification of Congestive Heart Failure]. [Internet]. 2011 [cited 2018 Mar 16]. Available at: http://www.invalidnost.com/publ/klassifikacija_khronicheskoj_serdechnoj_nedostatochnosti/1-1-0-21
4.^ Medpanorama. Khronicheskaya serdechnaya nedostatochnost, stadii. [Congestive Heart Failure, Stages]. [Internet]. 2004-2018 [cited 2018 Mar 16]. Available at: https://www.medpanorama.ru/zcardio/other/other-0033.shtml
5.^ World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for ;2016. Chapter IX: Diseases of the circulatory system (I00-I99) [Internet]. Geneva: World Health Organization. 2016 [cited 2018 Mar 16]. Available at: http://apps.who.int/classifications/icd10/browse/2016/en#/I30-I52
6.^ World Health Organization. ICD 10 – Mezhdunarodnaya klassificatsia bolezney 10-go peresmotra; Versia 2018. [ICD 10 – International Classification of Diseases 10th Revision; Version for 2018]. Serdechnaya nedostatochnost [Heart Failure] [Internet]. Geneva: World Health Organization. 2018 [cited 2018 Mar 16]. Available at: http://mkb-10.com/index.php?pid=8241