Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multiparametric approach to heart failure prognosis.
OBJECTIVE
We built and validated a new heart failure (HF) prognostic model which integrates cardiopulmonary exercise test (CPET) parameters with easy-to-obtain clinical, laboratory, and echocardiographic variables.


BACKGROUND
HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty.


METHODS
Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041days (range 4-5185). Cox proportional hazard regression analysis with stepwise selection of variables was used, followed by cross-validation procedure. The study end-point was a composite of cardiovascular death and urgent heart transplant.


RESULTS
Six variables (hemoglobin, Na(+), kidney function by means of MDRD, left ventricle ejection fraction [echocardiography], peak oxygen consumption [% pred] and VE/VCO2 slope) out of the several evaluated resulted independently related to prognosis. A score was built from Metabolic Exercise Cardiac Kidney Indexes, the MECKI score, which identified the risk of study end-point with AUC values of 0.804 (0.754-0.852) at 1year, 0.789 (0.750-0.828) at 2years, 0.762 (0.726-0.799) at 3years and 0.760 (0.724-0.796) at 4years.


CONCLUSIONS
This is the first large-scale multicenter study where a prognostic score, the MECKI score, has been built for systolic HF patients considering CPET data combined with clinical, laboratory and echocardiographic measurements. In the present population, the MECKI score has been successfully validated, performing very high AUC.
Centro Cardiologicico Monzino, IRCCS, Milano, Italy. piergiuseppe.agostoni@unimi.it
Piergiuseppe
P
Agostoni
Ugo
U
Corrà
Gaia
G
Cattadori
Fabrizio
F
Veglia
Rocco
R
La Gioia
Angela B
AB
Scardovi
Michele
M
Emdin
Marco
M
Metra
Gianfranco
G
Sinagra
Giuseppe
G
Limongelli
Rossella
R
Raimondo
Federica
F
Re
Marco
M
Guazzi
Romualdo
R
Belardinelli
Gianfranco
G
Parati
Damiano
D
Magrì
Cesare
C
Fiorentini
Alessandro
A
Mezzani
Elisabetta
E
Salvioni
Domenico
D
Scrutinio
Renato
R
Ricci
Luca
L
Bettari
Andrea
A
Di Lenarda
Luigi E
LE
Pastormerlo
Giuseppe
G
Pacileo
Raffaella
R
Vaninetti
Anna
A
Apostolo
Annamaria
A
Iorio
Stefania
S
Paolillo
Pietro
P
Palermo
Mauro
M
Contini
Marco
M
Confalonieri
Pantaleo
P
Giannuzzi
Andrea
A
Passantino
Livio Dei
LD
Cas
Massimo F
MF
Piepoli
Claudio
C
Passino
D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000503:physiopathology*; D006334:Heart Function Tests / Q000379:methods* / Q000592:standards; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods* / Q000592:standards; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index