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
Centro Cardiologico Monzino, IRCCS, Heart Failure Unit, Via Carlo Parea, 4, 20138 Milan, Italy.
Department of Preventive Cardiology, Wroclaw Medical University, Wroclaw, Poland; Department for Biomedical Sciences for Health, University of Milan, Italy.
Int J Cardiol. 2023 Apr 1;376:90-96. doi: 10.1016/j.ijcard.2023.01.069. Epub 2023 Jan 27.
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 VO, VE/VCO slope, Na, LVEF, MDRD and Hb.
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).
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, V/VCO 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.
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.
国际指南强调了风险评分在心力衰竭（HF）管理中的作用。与本质上是动态且不稳定综合征的HF不同，其所有预后研究均基于单次评估。我们研究了一种公认的风险评分——MECKI评分的时间相关变化是否能增加预后价值。MECKI评分基于峰值VO、VE/VCO斜率、钠、左心室射血分数（LVEF）、肾脏病饮食改良试验（MDRD）和血红蛋白。
进行了一项多中心回顾性研究，纳入660例患者，这些患者至少间隔6个月进行一次MECKI重新评估。根据MECKI值的第二次评估与第一次评估之间的差异（MECKI II - MECKI I = ∆MECKI），将研究人群分为两组：评分降低组（∆MECKI <0，即临床改善）和评分增加组（∆MECKI >0，临床恶化）。
在随访期间重新评估时，MECKI评分的预后价值也得到了证实。MECKI改善组（366例患者）与MECKI恶化组（294例患者）相比，预后更好（p <0.0001）。在第一次评估时，两组在LVEF、V/VCO斜率和血钠浓度方面存在差异，而在第二次评估时，两组在评分所考虑的所有6个参数方面均存在差异。MECKI评分改善的患者，除血红蛋白外，评分的所有组成部分均有所改善，而评分恶化的患者，所有参数均恶化。
本研究表明，重新评估MECKI评分可识别出风险较高的HF患者，评分的改善或恶化涉及多个产生MECKI评分的参数，证实了HF的整体背景。
