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Exercise Performance Is a Prognostic Indicator in Elderly Patients With Chronic Heart Failure--Application of
Valentina Carubelli1, Marco Metra, Ugo Corrà
1Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia.
Insights
The Metabolic Exercise Cardiac Kidney Indexes (MECKI) score predicts cardiovascular death and transplant needs in heart failure (HF) patients. This score remains valuable for older HF patients, despite their reduced exercise capacity.
Area of Science:
- Cardiology
- Geriatrics
- Clinical Medicine
Background:
- The Metabolic Exercise Cardiac Kidney Indexes (MECKI) score predicts cardiovascular death and urgent heart transplantation in chronic heart failure (HF).
- Older HF patients often have more comorbidities and lower exercise tolerance.
- The prognostic value of the MECKI score in relation to age and exercise capacity requires further investigation.
Purpose of the Study:
- To investigate the relationship between age, exercise tolerance, and the prognostic value of the MECKI score in patients with chronic systolic HF.
- To determine if the prognostic power of the MECKI score differs between older (≥70 years) and younger HF patients.
Main Methods:
- Analysis of data from 3,794 patients with chronic systolic HF.
- Primary endpoint: composite of cardiovascular death and urgent heart transplantation.
- Multivariable analysis and receiver operating characteristic (ROC) curve analysis to assess predictors and prognostic power across age groups.
Main Results:
- Older patients exhibited higher comorbidity prevalence and reduced exercise performance (peak V̇O2, V̇E/V̇CO2slope) compared to younger patients.
- The primary endpoint rate was higher in the oldest quartile (19%) versus the youngest (14%).
- MECKI score increased with age, and its prognostic power was consistent across age groups (≥70 and <70 years) via ROC analysis.
Conclusions:
- Older patients with HF represent a high-risk group with diminished exercise performance.
- The MECKI score demonstrates increasing values with age and retains its prognostic significance in elderly HF patients.
Background:
In patients with chronic heart failure (HF) the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score, is a predictor of cardiovascular death and urgent heart transplantation. We investigated the relationship between age, exercise tolerance and the prognostic value of the MECKI score.
Methods And Results:
We analyzed data from 3,794 patients with chronic systolic HF. The primary endpoint was a composite of cardiovascular death and urgent heart transplantation. Older patients had higher prevalence of comorbidities and lower exercise performance compared with younger subjects (peak V̇O2, 925 vs. 1,351 L/min; P<0.0001; V̇E/V̇CO2slope, 33.2 vs. 28.3; P>0.0001). The rate of the primary endpoint was 19% in the highest age quartile and 14% in the lowest quartile. At multivariable analysis, the independent predictors of the primary endpoint were left ventricular ejection fraction (LVEF), eGFR, peak V̇O2, serum Na(+)and the use of β-blockers in patients aged ≥70 years, and LVEF, eGFR and peak V̇O2in younger subjects. The MECKI risk score increased across age subgroups, but on receiver operating characteristic curve analysis its prognostic power was similar in both patients aged ≥70 and <70 years.
Conclusions:
Older patients with HF are a high-risk population with lower exercise performance. The MECKI score increased according to age and maintained its prognostic value also in older patients.
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