title: The metabolic exercise test data combined with Cardiac And Kidney Indexes (MECKI) score and prognosis in heart failure. A validation study.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy. Electronic address: ucorra@fsm.it.
authors.forename: Ugo
authors.initials: U
authors.lastname: Corrà
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department Of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano.
authors.forename: Piergiuseppe
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Bioengineering Department, Salvatore Maugeri Foundation, IRCCS, Veruno, NO, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Gaia
authors.initials: G
authors.lastname: Cattadori
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy; Section of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Battaia
authors.affiliation: Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors.forename: Rocco
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authors.lastname: La Gioia
authors.affiliation: UOC Cardiologia Ospedale S. Spirito, Roma Lungotevere in Sassia 3, Roma, Italy.
authors.forename: Angela B
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authors.affiliation: Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy.
authors.forename: Michele
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authors.affiliation: Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy.
authors.forename: Marco
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authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
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authors.affiliation: Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy.
authors.forename: Giuseppe
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authors.lastname: Limongelli
authors.affiliation: Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, Tradate, Italy.
authors.forename: Rosa
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authors.affiliation: Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, St.Camillo-Forlanini Hospital, Roma, Italy.
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authors.lastname: Re
authors.affiliation: Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, Milano, Italy.
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authors.affiliation: Dept of Health Science, University of Milano Bicocca & Dept of Cardiology, S.Luca Hospital, Istituto Auxologico Italiano, Milano, Italy.
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authors.lastname: Parati
authors.affiliation: Dipartimento di Medicina Clinica e Molecolare, "Sapienza" Università degli Studi di Roma, Roma, Italy.
authors.forename: Damiano
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authors.lastname: Magrì
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy; Department Of Clinical Sciences and Community Health, Cardiovascular Section, Università di Milano, Milano.
authors.forename: Cesare
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authors.lastname: Fiorentini
authors.affiliation: Section of Cardiology, Department of Medicine, University of Verona, Italy.
authors.forename: Mariantonietta
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Elisabetta
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Marta
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Fabrizio
authors.initials: F
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authors.affiliation: Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy.
authors.forename: Alessandro
authors.initials: A
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authors.affiliation: Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy.
authors.forename: Domenico
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authors.affiliation: Centro Cardiovascolare, Azienda per i Servizi Sanitari n°1, Trieste, Italy.
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authors.affiliation: UOC Cardiologia Ospedale S. Spirito, Roma Lungotevere in Sassia 3, Roma, Italy.
authors.forename: Roberto
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
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authors.affiliation: Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Iorio
authors.affiliation: Department of advanced biomedical sciences, Federico II University, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Paolillo
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Pietro
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
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authors.affiliation: Section of Cardiology, Department of Medicine, University of Verona, Italy.
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authors.affiliation: Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Scuola Superiore S. Anna, Pisa, Italy.
authors.forename: Claudio
authors.initials: C
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authors.affiliation: Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy.
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authors.initials: MF
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
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authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milano, Italy.
authors.forename: Francesca
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authors.affiliation: Cardiologia Riabilitativa, Azienda Ospedali Riuniti, Ancona, Italy.
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authors.affiliation: Istituto Auxologico Italiano, Italy.
authors.forename: Gabriella
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authors.affiliation: Cardiologia SUN, Ospedale Monaldi Napoli, Italy.
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authors.affiliation: Cardiologia SUN, Ospedale Monaldi Napoli, Italy.
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authors.forename: Raffaele
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authors.affiliation: CNR-Milano, Italy.
authors.forename: Renata
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authors.lastname: De Maria
authors.affiliation: "S. Maugeri" Foundation, IRCCS, Cassano Murge, Italy.
authors.forename: Daniela
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authors.lastname: Santoro
authors.affiliation: "S. Maugeri" Foundation, IRCCS, Cassano Murge, Italy.
authors.forename: Saba
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authors.lastname: Campanale
authors.affiliation: "S. Maugeri" Foundation, IRCCS, Cassano Murge, Italy.
authors.forename: Domenica
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authors.lastname: Caputo
authors.affiliation: "S. Maugeri" Foundation, Tradate, Italy.
authors.forename: Donatella
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authors.lastname: Bertipaglia
authors.affiliation: Ospedali Riuniti and University of Trieste, Italy.
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mesh_terms: D000368:Aged; D005080:Exercise Test / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery; D006334:Heart Function Tests / Q000379:methods / Q000592:standards; D016027:Heart Transplantation / Q000379:methods* / Q000592:standards; D006801:Humans; D007677:Kidney Function Tests / Q000379:methods / Q000592:standards; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology
keywords: Heart failure; Prognosis, score