Frontiers in Cardiovascular Medicine (Jul 2024)

A matter of sex—persistent predictive value of MECKI score prognostic power in men and women with heart failure and reduced ejection fraction: a multicenter study

  • Giulia Grilli,
  • Elisabetta Salvioni,
  • Federica Moscucci,
  • Alice Bonomi,
  • Gianfranco Sinagra,
  • Michele Schaeffer,
  • Jeness Campodonico,
  • Massimo Mapelli,
  • Massimo Mapelli,
  • Maddalena Rossi,
  • Cosimo Carriere,
  • Michele Emdin,
  • Michele Emdin,
  • Massimo Piepoli,
  • Massimo Piepoli,
  • Stefania Paolillo,
  • Michele Senni,
  • Claudio Passino,
  • Anna Apostolo,
  • Federica Re,
  • Caterina Santolamazza,
  • Damiano Magrì,
  • Carlo M. Lombardi,
  • Ugo Corrà,
  • Rosa Raimondo,
  • Antonio Cittadini,
  • Antonio Cittadini,
  • Annamaria Iorio,
  • Andrea Salzano,
  • Andrea Salzano,
  • Rocco Lagioia,
  • Carlo Vignati,
  • Roberto Badagliacca,
  • Andrea Passantino,
  • Pasquale Perrone Filardi,
  • Michele Correale,
  • Enrico Perna,
  • Davide Girola,
  • Marco Metra,
  • Gaia Cattadori,
  • Gaia Cattadori,
  • Marco Guazzi,
  • Giuseppe Limongelli,
  • Gianfranco Parati,
  • Gianfranco Parati,
  • Fabiana De Martino,
  • Maria Vittoria Matassini,
  • Francesco Bandera,
  • Francesco Bandera,
  • Maurizio Bussotti,
  • Angela Beatrice Scardovi,
  • Susanna Sciomer,
  • Piergiuseppe Agostoni,
  • Piergiuseppe Agostoni,
  • MECKI Score Research Group,
  • Armando Ferraretti,
  • Cristina Gussago,
  • Domenico Scrutinio,
  • Donatella Bertipaglia,
  • Elisa Battaia,
  • Michele Moretti,
  • Francesca Pietrucci,
  • Geza Halasz,
  • Bruno Capelli,
  • Giovanna Gallo,
  • Emiliano Fiori,
  • Giovanni Marchese,
  • Giuseppe Pacileo,
  • Fabio Valente,
  • Rossella Vastarella,
  • Rita Gravino,
  • Matilda Shkoza,
  • Nikita Baracchini,
  • Teresa Capovilla,
  • Andrea Di Lenarda,
  • Alberto Maria Marra,
  • Roberta D’Assante,
  • Giulia Crisci,
  • Roberto Ricci,
  • Luca Arcari,
  • Sergio Caravita,
  • Elena Viganò,
  • Stefania Farina,
  • Beatrice Pezzuto,
  • Pietro Palermo,
  • Mauro Contini,
  • Paola Gugliandolo,
  • Irene Mattavelli,
  • Michele Della Rocca

DOI
https://doi.org/10.3389/fcvm.2024.1390544
Journal volume & issue
Vol. 11

Abstract

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BackgroundA sex-based evaluation of prognosis in heart failure (HF) is lacking.Methods and resultsWe analyzed the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score registry, which includes HF with reduced ejection fraction (HFrEF) patients. A cross-validation procedure was performed to estimate weights separately for men and women of all MECKI score parameters: left ventricular ejection fraction (LVEF), hemoglobin, kidney function assessed by Modification of Diet in Renal Disease, blood sodium level, ventilation vs. carbon dioxide production slope, and peak oxygen consumption (peakVO2). The primary outcomes were the composite of all-cause mortality, urgent heart transplant, and implant of a left ventricle assist device. The difference in predictive ability between the native and sex recalibrated MECKI (S-MECKI) was calculated using a receiver operating characteristic (ROC) curve at 2 years and a calibration plot. We retrospectively analyzed 7,900 HFrEF patients included in the MECKI score registry (mean age 61 ± 13 years, 6,456 men/1,444 women, mean LVEF 33% ± 10%, mean peakVO2 56.2% ± 17.6% of predicted) with a median follow-up of 4.05 years (range 1.72–7.47). Our results revealed an unadjusted risk of events that was doubled in men compared to women (9.7 vs. 4.1) and a significant difference in weight between the sexes of most of the parameters included in the MECKI score. S-MECKI showed improved risk classification and accuracy (area under the ROC curve: 0.7893 vs. 0.7799, p = 0.02) due to prognostication improvement in the high-risk settings in both sexes (MECKI score >10 in men and >5 in women).ConclusionsS-MECKI, i.e., the recalibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.

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