Ross heart failure classification for infants and children

Johnson Francis | February 22, 2022 | General Cardiology | No Comments

Ross heart failure classification for infants and children

All of us are familiar with the New York Heart Association (NYHA) functional classification. But it is not applicable to most of the pediatric population. Ross RD et al tried to determine which variables most accurately define congestive heart failure in infants [1]. Forty one patients with median age of 2.5 months were graded by four pediatric cardiologists for the presence and severity of congestive heart failure based on several parameters. The parameters evaluated were amount of formula consumed per feeding, feeding time, history of diaphoresis or tachypnea, growth parameters, respiratory and heart rates, respiratory pattern, perfusion, presence of edema, diastolic filling sounds, and hepatomegaly. In that study, 19 patients were graded as having no congestive heart failure, nine as mild, seven as moderate and six as severe congestive heart failure. This seminal work led to the Ross classification for heart failure in infants. Later the classification was modified to include all children.

The modified Ross heart failure classification for children is widely cited and is as follows [2]:

Class I: Asymptomatic

Class II: Mild tachypnea or diaphoresis with feeding in infants; Dyspnea on exertion in older children

Class III: Marked tachypnea or diaphoresis with feeding in infants and prolonged feeding times with growth failure; marked dyspnea on exertion in older children

Class IV: Tachypnea, retractions, grunting or diaphoresis at rest.

In general, it can be seen that it corresponds to the NYHA functional classification with addition of features specific for infants.

In 2012, Ross RD reviewed the classification and suggested an age-stratified scoring system [3]. In that article, it was mentioned that several modifications for the initial system have been used and others proposed. Grading of signs and symptoms in children is dependent on age because infants manifest heart failure differently than toddlers and older children. It was also noted that in addition to signs and symptoms, data from echocardiography, exercise testing and biomarkers like N-terminal pro-brain natriuretic peptide (NT-proBNP) are useful in stratifying outcomes in children with heart failure.

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