title: Exercise Performance Is a Prognostic Indicator in Elderly Patients With Chronic Heart Failure--Application of Metabolic Exercise Cardiac Kidney Indexes Score.
abstract: 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.
  
  
  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.
authors.affiliation: Division of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University and Civil Hospital of Brescia.
authors.forename: Valentina
authors.initials: V
authors.lastname: Carubelli
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Ugo
authors.initials: U
authors.lastname: Corrà
authors.forename: Damiano
authors.initials: D
authors.lastname: Magrì
authors.forename: Claudio
authors.initials: C
authors.lastname: Passino
authors.forename: Carlo
authors.initials: C
authors.lastname: Lombardi
authors.forename: Domenico
authors.initials: D
authors.lastname: Scrutinio
authors.forename: Michele
authors.initials: M
authors.lastname: Correale
authors.forename: Gaia
authors.initials: G
authors.lastname: Cattadori
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Salvioni
authors.forename: Marta
authors.initials: M
authors.lastname: Giovannardi
authors.forename: Rosa
authors.initials: R
authors.lastname: Raimondo
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.forename: Romualdo
authors.initials: R
authors.lastname: Belardinelli
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Limongelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Clemenza
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Parati
authors.forename: Angela B
authors.initials: AB
authors.lastname: Scardovi
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Maurizio
authors.initials: M
authors.lastname: Bussotti
authors.forename: Rocco
authors.initials: R
authors.lastname: La Gioia
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease; D016208:Databases, Factual; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007668:Kidney / Q000378:metabolism / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010100:Oxygen / Q000097:blood; D012964:Sodium / Q000097:blood; D013318:Stroke Volume
chemical_list: D000319:Adrenergic beta-Antagonists; D012964:Sodium; D010100:Oxygen