5
Table 4. ACHD AP Classification (CHD Anatomy +
Physiological Stage = ACHD AP Classification)
Physiological Stage
Stage C
BNP or NT-proBNP level ≥2 times the upper limit of normal
Hemodynamically significant shunt*
Mild or moderate chronic hypoxemia* (baseline resting oxygen saturation 86–92%)
Moderate or greater valvular dysfunction*
Moderate or severe ventricular dysfunction (systemic, pulmonic, or both)
Pulmonary arterial hypertension (low-risk)*
Sustained or high-burden tachyarrhythmia in the past 12 months requiring treatment
with antiarrhythmic drugs, ablation, cardioversion, or ICD therapy
Stage D
Hospitalization for heart failure in the past 12 months
Endocarditis in the prior 1 year
Eisenmenger syndrome
NYHA functional class* III or IV symptoms
Recurrent arrhythmias* that are hemodynamically significant and/or refractory to treatment
Severe hypoxemia* (baseline oxygen saturation ≤85%)
Pulmonary arterial hypertension* (intermediate- or high-risk)
Modified with permission from Stout et al. Copyright © 2018 American Heart Association, Inc.
and American College of Cardiolog y Foundation.
* See Table 5.
ACHD indicates adult congenital heart disease; AP, anatomic and physiological; ASD, atrial
septal defect; BNP, B-type natriuretic peptide; ICD, implantable cardioverter-defibrillator;
NT-proBNP, N-terminal prohormone of B-type natriuretic peptide; NYHA, New York
Heart Association; PDA, patent ductus arteriosus; TGA, transposition of the great arteries;
and VSD, ventricular septal defect.
(cont'd)
