Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: a multiparametric approach to heart failure prognosis.

We built and validated a new heart failure (HF) prognostic model which integrates cardiopulmonary exercise test (CPET) parameters with easy-to-obtain clinical, laboratory, and echocardiographic variables. HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty. Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041days (range 4-5185). Cox proportional hazard regression analysis with stepwise selection of variables was used, followed by cross-validation procedure. The study end-point was a composite of cardiovascular death and urgent heart transplant. Six variables (hemoglobin, Na(+), kidney function by means of MDRD, left ventricle ejection fraction [echocardiography], peak oxygen consumption [% pred] and VE/VCO2 slope) out of the several evaluated resulted independently related to prognosis. A score was built from Metabolic Exercise Cardiac Kidney Indexes, the MECKI score, which identified the risk of study end-point with AUC values of 0.804 (0.754-0.852) at 1year, 0.789 (0.750-0.828) at 2years, 0.762 (0.726-0.799) at 3years and 0.760 (0.724-0.796) at 4years. This is the first large-scale multicenter study where a prognostic score, the MECKI score, has been built for systolic HF patients considering CPET data combined with clinical, laboratory and echocardiographic measurements. In the present population, the MECKI score has been successfully validated, performing very high AUC.

Agostoni P ，Corrà U ，Cattadori G ，Veglia F ，La Gioia R ，Scardovi AB ，Emdin M ，Metra M ，Sinagra G ，Limongelli G ，Raimondo R ，Re F ，Guazzi M ，Belardinelli R ，Parati G ，Magrì D ，Fiorentini C ，Mezzani A ，Salvioni E ，Scrutinio D ，Ricci R ，Bettari L ，Di Lenarda A ，Pastormerlo LE ，Pacileo G ，Vaninetti R ，Apostolo A ，Iorio A ，Paolillo S ，Palermo P ，Contini M ，Confalonieri M ，Giannuzzi P ，Passantino A ，Cas LD ，Piepoli MF ，Passino C ，MECKI Score Research Group ... -  《-》

The metabolic exercise test data combined with Cardiac And Kidney Indexes (MECKI) score and prognosis in heart failure. A validation study.

The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a prognostic model to identify heart failure (HF) patients at risk for cardiovascular mortality (CVM) and urgent heart transplantation (uHT) based on 6 routine clinical parameters: hemoglobin, sodium, kidney function by the Modification of Diet in Renal Disease (MDRD) equation, left ventricle ejection fraction (LVEF), percentage of predicted peak oxygen consumption (VO2) and VE/VCO2 slope. MECKI score must be generalizable to be considered useful: therefore, its performance was validated in a new sequence of HF patients. Both the development (MECKI-D) and the validation (MECKI-V) cohorts were composed of consecutive HF patients with LVEF <40% able to perform a symptom-limited cardiopulmonary exercise testing. The CVM or uHT rates were analyzed at one, two and three years in both cohorts: all patients with a censoring time shorter than the scheduled follow-up were excluded, while those with events occurring after 1, 2 and 3 years were considered as censored. MECKI-D and MECKI-V consisted of 2009 and 992 patients, respectively. MECKI-V patients had a higher LVEF, higher peak VO2 and lower VE/VCO2 slope, higher prescription of beta-blockers and device therapy: after the 3-year follow-up, CVM or uHT occurred in 206 (18%) MECKI-D and 44 (13%) MECKI-V patients (p<0.000), respectively. MECKI-V AUC values at one, two and three years were 0.81 ± 0.04, 0.76 ± 0.04, and 0.80 ± 0.03, respectively, not significantly different from MECKI-D. MECKI score preserves its predictive ability in a HF population at a lower risk.

Corrà U ，Agostoni P ，Giordano A ，Cattadori G ，Battaia E ，La Gioia R ，Scardovi AB ，Emdin M ，Metra M ，Sinagra G ，Limongelli G ，Raimondo R ，Re F ，Guazzi M ，Belardinelli R ，Parati G ，Magrì D ，Fiorentini C ，Cicoira M ，Salvioni E ，Giovannardi M ，Veglia F ，Mezzani A ，Scrutinio D ，Di Lenarda A ，Ricci R ，Apostolo A ，Iorio AM ，Paolillo S ，Palermo P ，Contini M ，Vassanelli C ，Passino C ，Giannuzzi P ，Piepoli MF ，MECKI Score Research Group ，Other Members of the MECKI Score research Group ，Antonioli L ，Segurini C ，Bertella E ，Farina S ，Bovis F ，Pietrucci F ，Malfatto G ，Roselli T ，Buono A ，Calabrò R ，De Maria R ，Santoro D ，Campanale S ，Caputo D ，Bertipaglia D ，Berton E ... -  《-》

Prognostic value of indeterminable anaerobic threshold in heart failure.

Agostoni P ，Corrà U ，Cattadori G ，Veglia F ，Battaia E ，La Gioia R ，Scardovi AB ，Emdin M ，Metra M ，Sinagra G ，Limongelli G ，Raimondo R ，Re F ，Guazzi M ，Belardinelli R ，Parati G ，Magrì D ，Fiorentini C ，Cicoira M ，Salvioni E ，Giovannardi M ，Mezzani A ，Scrutinio D ，Di Lenarda A ，Mantegazza V ，Ricci R ，Apostolo A ，Iorio A ，Paolillo S ，Palermo P ，Contini M ，Vassanelli C ，Passino C ，Piepoli MF ，MECKI Score Research Group ... -  《-》

Prognostic value of a new cardiopulmonary exercise testing parameter in chronic heart failure: oxygen uptake efficiency at peak exercise - comparison with oxygen uptake efficiency slope.

A growing body of evidence shows the prognostic value of oxygen uptake efficiency slope (OUES), a cardiopulmonary exercise test (CPET) parameter derived from the logarithmic relationship between O(2) consumption (VO(2)) and minute ventilation (VE) in patients with chronic heart failure (CHF). To evaluate the prognostic value of a new CPET parameter - peak oxygen uptake efficiency (POUE) - and to compare it with OUES in patients with CHF. We prospectively studied 206 consecutive patients with stable CHF due to dilated cardiomyopathy - 153 male, aged 53.3±13.0 years, 35.4% of ischemic etiology, left ventricular ejection fraction 27.7±8.0%, 81.1% in sinus rhythm, 97.1% receiving ACE-Is or ARBs, 78.2% beta-blockers and 60.2% spironolactone - who performed a first maximal symptom-limited treadmill CPET, using the modified Bruce protocol. In 33% of patients an cardioverter-defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) was implanted during follow-up. Peak VO(2), percentage of predicted peak VO(2), VE/VCO(2) slope, OUES and POUE were analyzed. OUES was calculated using the formula VO(2) (l/min) = OUES (log(10)VE) + b. POUE was calculated as pVO(2) (l/min) / log(10)peakVE (l/min). Correlation coefficients between the studied parameters were obtained. The prognosis of each variable adjusted for age was evaluated through Cox proportional hazard models and R2 percent (R2%) and V index (V6) were used as measures of the predictive accuracy of events of each of these variables. Receiver operating characteristic (ROC) curves from logistic regression models were used to determine the cut-offs for OUES and POUE. pVO(2): 20.5±5.9; percentage of predicted peak VO(2): 68.6±18.2; VE/VCO(2) slope: 30.6±8.3; OUES: 1.85±0.61; POUE: 0.88±0.27. During a mean follow-up of 33.1±14.8 months, 45 (21.8%) patients died, 10 (4.9%) underwent urgent heart transplantation and in three patients (1.5%) a left ventricular assist device was implanted. All variables proved to be independent predictors of this combined event; however, VE/VCO2 slope was most strongly associated with events (HR 11.14). In this population, POUE was associated with a higher risk of events than OUES (HR 9.61 vs. 7.01), and was also a better predictor of events (R2: 28.91 vs. 22.37). POUE was more strongly associated with death, urgent heart transplantation and implantation of a left ventricular assist device and proved to be a better predictor of events than OUES. These results suggest that this new parameter can increase the prognostic value of CPET in patients with CHF.

Toste A ，Soares R ，Feliciano J ，Andreozzi V ，Silva S ，Abreu A ，Ramos R ，Santos N ，Ferreira L ，Ferreira RC ... -  《Revista Portuguesa de Cardiologia》

Cardiopulmonary exercise testing and prognosis in heart failure due to systolic left ventricular dysfunction: a validation study of the European Society of Cardiology Guidelines and Recommendations (2008) and further developments.

Corrà U ，Giordano A ，Mezzani A ，Gnemmi M ，Pistono M ，Caruso R ，Giannuzzi P ... -  《-》