Forrester classification
The Forrester classification is used to classify acute heart failure according to hemodynamic criteria. Assessment criteria are the cardiac pump performance (measured as cardiac output in liters per minute) and the filling pressure of the left ventricle (measured as wedge pressure in mmHg ). These measured values are determined with the help of a right heart catheter . Similar to the NYHA classification based on anamnestic and clinical criteria, a distinction is made between four classes, but these do not match each other.
- Class I: normal blood flow behavior. There are no rattling noises in the lungs , cardiac ejection performance and pressure in the pulmonary vessels are in the physiological range.
- Class II: the filling pressure of the ventricle is increased, but the ejection performance is normal. The high filling pressure causes blood to back up in the pulmonary vessels, pulmonary edema can develop, pulmonary rattling noises are present. The body periphery is supplied normally. This constellation is sometimes referred to as reverse failure referred to the left heart.
- Class III: normal filling pressure of the left ventricle, therefore no blood backflow into the lungs, no pulmonary edema and no pulmonary rattling noises. However, the decreased cardiac output leads to an undersupply of the periphery, sometimes referred to as forward failure of the left heart.
- Class IV: increased filling pressure of the chamber, decreased cardiac output. There is a backlog of blood in the pulmonary vessels and an undersupply of the periphery. This combination of forward and backward failure is often referred to as cardiogenic shock .
The Forrester classification is used to control the most optimal intensive care therapy for acute heart failure. For example, vasodilators such as nitroglycerine and molsidomine lead to an advantageous reduction in pulmonary congestion without adverse hemodynamic changes in patients with an acute Forrester class II myocardial infarction . In class III patients, on the other hand, vasodilators cause a drop in cardiac output; for them, careful volume supply is more advisable.
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- JS Forrester, DD Waters: Hospital treatment of congestive heart failure. Management according to the hemodynamic profile . Am J Med (1978) 65: 173-80. PMID 685990 .
- K. Kodama et al .: Hemodynamic and metabolic effects of vasodilator therapy for heart failure in acute myocardial infarction . Jpn Circ J (1984) 48: 380-7. PMID 6425527 .
