Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multiparametric approach to heart failure prognosis

Abstract

Objectives: 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.

Keywords: AT; Anaerobic threshold; BMI; BNP; Body mass index; Brain Natriuretic Peptide; CPET; CRT; Carbon dioxide consumption; Cardiac resynchronization therapy; Cardiopulmonary exercise test; HF; HF survival score; HFSS; HR; Hb; Heart Failure; Heart failure; Heart rate; Hemoglobin; ICD; Implantable cardioverter–defibrillator; K(+); LVEF; LVeDV; LVeSV; Left Ventricular Ejection Fraction; Left Ventricular End-Diastolic Volume; Left Ventricular End-Systolic Volume; MDRD; Modification of Diet in Renal Disease; NYHA; Na(+); New York Heart Association; Oxygen consumption; Oxygen uptake; PM; Pace maker; Potassium; Prognosis; RER; RR; Respiratory Rate; Respiratory exchange ratio; SHFM; Seattle Heart Failure Model; Sodium; TV; Tidal Volume; VCO(2); VE; VO(2); Ventilation.