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. 2024 Jul 3:11:1390544.
doi: 10.3389/fcvm.2024.1390544. eCollection 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  1 , Elisabetta Salvioni  1 , Federica Moscucci  2 , Alice Bonomi  1 , Gianfranco Sinagra  3 , Michele Schaeffer  4 , Jeness Campodonico  1 , Massimo Mapelli  1   5 , Maddalena Rossi  3 , Cosimo Carriere  3 , Michele Emdin  6   7 , Massimo Piepoli  8   9 , Stefania Paolillo  10 , Michele Senni  11 , Claudio Passino  6 , Anna Apostolo  1 , Federica Re  12 , Caterina Santolamazza  13 , Damiano Magrì  14 , Carlo M Lombardi  15 , Ugo Corrà  16 , Rosa Raimondo  17 , Antonio Cittadini  18   19 , Annamaria Iorio  11 , Andrea Salzano  20   21 , Rocco Lagioia  22 , Carlo Vignati  1 , Roberto Badagliacca  23 , Andrea Passantino  24 , Pasquale Perrone Filardi  25 , Michele Correale  26 , Enrico Perna  13 , Davide Girola  27 , Marco Metra  28 , Gaia Cattadori  5   29 , Marco Guazzi  30 , Giuseppe Limongelli  31 , Gianfranco Parati  32   33 , Fabiana De Martino  34 , Maria Vittoria Matassini  35 , Francesco Bandera  36   37 , Maurizio Bussotti  38 , Angela Beatrice Scardovi  39 , Susanna Sciomer  23 , Piergiuseppe Agostoni  1   5 ; MECKI Score Research Group
Collaborators, Affiliations

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 et al. Front Cardiovasc Med. .

Abstract

Background: A sex-based evaluation of prognosis in heart failure (HF) is lacking.

Methods and results: We 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).

Conclusions: S-MECKI, i.e., the recalibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.

Keywords: MECKI score; heart failure with reduced ejection fraction; prognosis; risk; sex.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor RDP declared a past co-authorship with the author GP. The authors declared that they were an editorial board member of Frontiers at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
ROC analysis of native MECKI vs. S-MECKI scores in the whole study population.
Figure 2
Figure 2
ROC analysis of native MECKI (A) vs. S-MECKI (B) scores.
Figure 3
Figure 3
Calibration plots of native MECKI (A) and S-MECKI (B) scores in the whole study population.
Figure 4
Figure 4
Calibration plots of native (A) and S-MECKI (B) scores in the male subgroup.
Figure 5
Figure 5
Calibration plots of native MECKI (A) and S-MECKI (B) scores in the female subgroup.
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