Heart Failure and Heart Transplant Units, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea, 176 74, Attica, Greece.
Telecardiology Center, National Institute of Cardiology, Alpejska 42, 04-628 Warszawa, Poland.
Eur J Prev Cardiol. 2023 Sep 20;30(13):1371-1379. doi: 10.1093/eurjpc/zwad191.
Current European heart failure (HF) guidelines suggest the use of risk score: among them, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has demonstrated to be one of the most accurate. However, the risk scores are still poorly implemented in clinical practice, also due to the lack of strong evidence regarding their external validation in different populations. Thus, the current study was designed as an external validation test of the MECKI score in an international multicentre setting.
The study cohort consisted of patients diagnosed with HF with reduced ejection fraction (HFrEF) across international centres (not Italian), retrospectively recruited. Collected data included demographics, HF aetiology, laboratory testing, electrocardiogram (ECG), echocardiographic findings, and cardiopulmonary exercise testing (CPET) results as described in the original MECKI score publication. A total of 1042 patients across 8 international centres (7 European and 1 Asian) were included and followed up from 1998 till 2019. Patients were divided according to the calculated MECKI scores into three subgroups: (i) MECKI score <10%, (ii) 10-20%, and (iii) ≥ 20%. Survival analysis comparison among the three MECKI score subgroups showed a worse prognosis in patients with higher MECKI score value: median event-free survival times were 4396 days for MECKI score <10%, 3457 days for 10-20%, and 1022 days for ≥20% (P < 0.0001). Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were like those reported in the original internal validation studies.
In patients diagnosed with HFrEF, the power of the MECKI score was confirmed in terms of prognosis and risk stratification, supporting its implementation as advised by the HF guidelines.
目前欧洲心力衰竭（HF）指南建议使用风险评分：其中，代谢运动测试数据与心脏和肾脏指数（MECKI）评分相结合的评分被证明是最准确的评分之一。然而，风险评分在临床实践中的应用仍然很差，这也是由于缺乏关于其在不同人群中外部验证的强有力证据。因此，本研究旨在在国际多中心环境中对 MECKI 评分进行外部验证测试。
研究队列由国际中心（非意大利）回顾性招募的诊断为射血分数降低的心力衰竭（HFrEF）患者组成。收集的数据包括人口统计学、HF 病因、实验室检查、心电图（ECG）、超声心动图发现和心肺运动测试（CPET）结果，如原始 MECKI 评分出版物中所述。共纳入 8 个国际中心（7 个欧洲和 1 个亚洲）的 1042 例患者，并从 1998 年随访至 2019 年。根据计算的 MECKI 评分将患者分为三组：（i）MECKI 评分<10%，（ii）10-20%，和（iii）≥20%。三组 MECKI 评分亚组之间的生存分析比较显示，MECKI 评分较高的患者预后较差：MECKI 评分<10%的患者中位无事件生存时间为 4396 天，10-20%的患者为 3457 天，≥20%的患者为 1022 天（P<0.0001）。接受者操作特征（ROC）曲线和 ROC 曲线下面积（AUC）与原始内部验证研究报告的相似。
在诊断为 HFrEF 的患者中，MECKI 评分在预后和风险分层方面的效能得到了证实，支持 HF 指南建议的实施。
