Background: The role of risk scores in heart failure (HF) management has been highlighted by international guidelines. In contrast with HF, which is intrinsically a dynamic and unstable syndrome, all its prognostic studies have been based on a single evaluation. We investigated whether time-related changes of a well-recognized risk score, the MECKI score, added prognostic value. MECKI score is based on peak VO2, VE/VCO2 slope, Na+, LVEF, MDRD and Hb. Methods: A multi-centre retrospective study was conducted involving 660 patients who performed MECKI re-evaluation at least 6 months apart. Based on the difference between II and I evaluation of MECKI values (MECKI II - MECKI I = ∆ MECKI) the study population was divided in 2 groups: those presenting a score reduction (∆ MECKI <0, i.e. clinical improvement), vs. patients presenting an increase (∆ MECKI >0, clinical deterioration). Results: The prognostic value of MECKI score is confirmed also when re-assessed during follow-up. The group with improved MECKI (366 patients) showed a better prognosis compared to patients with worsened MECKI (294 patients) (p < 0.0001). At 1st evaluation, the two groups differentiated by LVEF, VE/VCO2 slope and blood Na+ concentration, while at 2nd evaluation they differentiated in all 6 parameters considered in the score. The patients who improved MECKI score, improved in all components of the score but hemoglobin, while patients who worsened the score, worsened all parameters. Conclusions: This study shows that re-assessment of MECKI score identifies HF subjects at higher risk and that score improvement or deterioration regards several MECKI score generating parameters confirming the holistic background of HF.

The importance of re-evaluating the risk score in heart failure patients: An analysis from the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database / Pezzuto, Beatrice; Piepoli, Massimo; Galotta, Arianna; Sciomer, Susanna; Zaffalon, Denise; Filomena, Domenico; Vignati, Carlo; Contini, Mauro; Alimento, Marina; Baracchini, Nikita; Apostolo, Anna; Palermo, Pietro; Mapelli, Massimo; Salvioni, Elisabetta; Carriere, Cosimo; Merlo, Marco; Papa, Silvia; Campodonico, Jeness; Badagliacca, Roberto; Sinagra, Gianfranco; Agostoni, Piergiuseppe. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 376:(2023), pp. 90-96. [10.1016/j.ijcard.2023.01.069]

The importance of re-evaluating the risk score in heart failure patients: An analysis from the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database

Pezzuto, Beatrice
Primo
;
Sciomer, Susanna;Filomena, Domenico;Papa, Silvia;Badagliacca, Roberto;
2023

Abstract

Background: The role of risk scores in heart failure (HF) management has been highlighted by international guidelines. In contrast with HF, which is intrinsically a dynamic and unstable syndrome, all its prognostic studies have been based on a single evaluation. We investigated whether time-related changes of a well-recognized risk score, the MECKI score, added prognostic value. MECKI score is based on peak VO2, VE/VCO2 slope, Na+, LVEF, MDRD and Hb. Methods: A multi-centre retrospective study was conducted involving 660 patients who performed MECKI re-evaluation at least 6 months apart. Based on the difference between II and I evaluation of MECKI values (MECKI II - MECKI I = ∆ MECKI) the study population was divided in 2 groups: those presenting a score reduction (∆ MECKI <0, i.e. clinical improvement), vs. patients presenting an increase (∆ MECKI >0, clinical deterioration). Results: The prognostic value of MECKI score is confirmed also when re-assessed during follow-up. The group with improved MECKI (366 patients) showed a better prognosis compared to patients with worsened MECKI (294 patients) (p < 0.0001). At 1st evaluation, the two groups differentiated by LVEF, VE/VCO2 slope and blood Na+ concentration, while at 2nd evaluation they differentiated in all 6 parameters considered in the score. The patients who improved MECKI score, improved in all components of the score but hemoglobin, while patients who worsened the score, worsened all parameters. Conclusions: This study shows that re-assessment of MECKI score identifies HF subjects at higher risk and that score improvement or deterioration regards several MECKI score generating parameters confirming the holistic background of HF.
2023
exercise capacity; heart failure; hemoglobin; prognosis; renal function; risk stratification
01 Pubblicazione su rivista::01a Articolo in rivista
The importance of re-evaluating the risk score in heart failure patients: An analysis from the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database / Pezzuto, Beatrice; Piepoli, Massimo; Galotta, Arianna; Sciomer, Susanna; Zaffalon, Denise; Filomena, Domenico; Vignati, Carlo; Contini, Mauro; Alimento, Marina; Baracchini, Nikita; Apostolo, Anna; Palermo, Pietro; Mapelli, Massimo; Salvioni, Elisabetta; Carriere, Cosimo; Merlo, Marco; Papa, Silvia; Campodonico, Jeness; Badagliacca, Roberto; Sinagra, Gianfranco; Agostoni, Piergiuseppe. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 376:(2023), pp. 90-96. [10.1016/j.ijcard.2023.01.069]
File allegati a questo prodotto
File Dimensione Formato  
Pezzuto_The-importance-of-re-evaluating_2023.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 1.38 MB
Formato Adobe PDF
1.38 MB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1670776
Citazioni
  • ???jsp.display-item.citation.pmc??? 3
  • Scopus 5
  • ???jsp.display-item.citation.isi??? 6
social impact