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The metabolic exercise test data combined with Cardiac And Kidney Indexes (MECKI) score and prognosis in heart
Ugo Corrà1, Piergiuseppe Agostoni2, Andrea Giordano3
1Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy.
Insights
The MECKI score effectively predicts cardiovascular mortality and urgent heart transplantation in heart failure patients. This prognostic model remains accurate even in lower-risk populations, demonstrating its generalizability.
Area of Science:
- Cardiology
- Clinical Prognostics
- Exercise Physiology
Background:
- The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated prognostic model.
- It identifies heart failure (HF) patients at risk for cardiovascular mortality (CVM) and urgent heart transplantation (uHT).
- The score utilizes six routine clinical parameters: hemoglobin, sodium, kidney function (MDRD), LVEF, peak VO2, and VE/VCO2 slope.
Purpose of the Study:
- To validate the generalizability of the MECKI score.
- To assess its performance in a new cohort of heart failure patients.
Main Methods:
- Two cohorts of consecutive HF patients with LVEF <40% were analyzed: a development cohort (MECKI-D) and a validation cohort (MECKI-V).
- Patients underwent symptom-limited cardiopulmonary exercise testing.
- Rates of CVM or uHT were analyzed at one, two, and three years, with appropriate censoring.
Main Results:
- The validation cohort (MECKI-V) included 992 patients, while the development cohort (MECKI-D) had 2009 patients.
- MECKI-V patients had generally better baseline characteristics (higher LVEF, peak VO2; lower VE/VCO2 slope).
- Three-year CVM or uHT rates were 18% in MECKI-D and 13% in MECKI-V (p<0.000). Area Under the Curve (AUC) values were comparable between cohorts at 1, 2, and 3 years (0.81, 0.76, 0.80 for MECKI-V).
Conclusions:
- The MECKI score maintains its predictive capability in a lower-risk heart failure population.
- This validates the score's generalizability and clinical utility.
Background:
The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a prognostic model to identify heart failure (HF) patients at risk for cardiovascular mortality (CVM) and urgent heart transplantation (uHT) based on 6 routine clinical parameters: hemoglobin, sodium, kidney function by the Modification of Diet in Renal Disease (MDRD) equation, left ventricle ejection fraction (LVEF), percentage of predicted peak oxygen consumption (VO2) and VE/VCO2 slope.
Objectives:
MECKI score must be generalizable to be considered useful: therefore, its performance was validated in a new sequence of HF patients.
Methods:
Both the development (MECKI-D) and the validation (MECKI-V) cohorts were composed of consecutive HF patients with LVEF <40% able to perform a symptom-limited cardiopulmonary exercise testing. The CVM or uHT rates were analyzed at one, two and three years in both cohorts: all patients with a censoring time shorter than the scheduled follow-up were excluded, while those with events occurring after 1, 2 and 3 years were considered as censored.
Results:
MECKI-D and MECKI-V consisted of 2009 and 992 patients, respectively. MECKI-V patients had a higher LVEF, higher peak VO2 and lower VE/VCO2 slope, higher prescription of beta-blockers and device therapy: after the 3-year follow-up, CVM or uHT occurred in 206 (18%) MECKI-D and 44 (13%) MECKI-V patients (p<0.000), respectively. MECKI-V AUC values at one, two and three years were 0.81 ± 0.04, 0.76 ± 0.04, and 0.80 ± 0.03, respectively, not significantly different from MECKI-D.
Conclusions:
MECKI score preserves its predictive ability in a HF population at a lower risk.
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