Ugo Corrà1, Piergiuseppe Agostoni2, Andrea Giordano3, Gaia Cattadori4, Elisa Battaia5, Rocco La Gioia6, Angela B Scardovi7, Michele Emdin8, Marco Metra9, Gianfranco Sinagra10, Giuseppe Limongelli11, Rosa Raimondo12, Federica Re13, Marco Guazzi14, Romualdo Belardinelli15, Gianfranco Parati16, Damiano Magrì17, Cesare Fiorentini2, Mariantonietta Cicoira18, Elisabetta Salvioni4, Marta Giovannardi4, Fabrizio Veglia4, Alessandro Mezzani19, Domenico Scrutinio6, Andrea Di Lenarda20, Roberto Ricci7, Anna Apostolo4, Anna Maria Iorio11, Stefania Paolillo21, Pietro Palermo4, Mauro Contini4, Corrado Vassanelli18, Claudio Passino22, Pantaleo Giannuzzi19, Massimo F Piepoli23, Laura Antonioli4, Chiara Segurini4, Erica Bertella4, Stefania Farina4, Francesca Bovis4, Francesca Pietrucci15, Gabriella Malfatto24, Teo Roselli25, Andrea Buono25, Raffaele Calabrò25, Renata De Maria26, Daniela Santoro27, Saba Campanale27, Domenica Caputo27, Donatella Bertipaglia28, Emanuela Berton29. 1. Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy. Electronic address: ucorra@fsm.it. 2. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department Of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano. 3. Bioengineering Department, Salvatore Maugeri Foundation, IRCCS, Veruno, NO, Italy. 4. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 5. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Section of Cardiology, Department of Medicine, University of Verona, Italy. 6. Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. 7. UOC Cardiologia Ospedale S. Spirito, Roma Lungotevere in Sassia 3, Roma, Italy. 8. Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy. 9. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy. 10. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. 11. Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy. 12. Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, Tradate, Italy. 13. Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, St.Camillo-Forlanini Hospital, Roma, Italy. 14. Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, Milano, Italy. 15. Cardiologia Riabilitativa, Azienda Ospedali Riuniti, Ancona, Italy. 16. Dept of Health Science, University of Milano Bicocca & Dept of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano, Milano, Italy. 17. Dipartimento di Medicina Clinica e Molecolare, "Sapienza" Università degli Studi di Roma, Roma, Italy. 18. Section of Cardiology, Department of Medicine, University of Verona, Italy. 19. Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy. 20. Centro Cardiovascolare, Azienda per i Servizi Sanitari n°1, Trieste, Italy. 21. Department of advanced biomedical sciences, Federico II University, Italy. 22. Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Scuola Superiore S. Anna, Pisa, Italy. 23. UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy. 24. Istituto Auxologico Italiano, Italy. 25. Cardiologia SUN, Ospedale Monaldi Napoli, Italy. 26. CNR-Milano, Italy. 27. "S. Maugeri" Foundation, IRCCS, Cassano Murge, Italy. 28. "S. Maugeri" Foundation, Tradate, Italy. 29. Ospedali Riuniti and University of Trieste, Italy.
Abstract
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.
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.