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

Piergiuseppe Agostoni, Ugo Corrà, Gaia Cattadori, Fabrizio Veglia, Rocco La Gioia, Angela B. Scardovi, Michele Emdin, Marco Metra, Gianfranco Sinagra, Giuseppe Limongelli, Rossella Raimondo, Federica Re, Marco Guazzi, Romualdo Belardinelli, Gianfranco Parati, Damiano Magrì, Cesare Fiorentini, Alessandro Mezzani, Elisabetta Salvioni, Domenico ScrutinioRenato Ricci, Luca Bettari, Andrea Di Lenarda, Luigi E. Pastormerlo, Giuseppe Pacileo, Raffaella Vaninetti, Anna Apostolo, Annamaria Iorio, Stefania Paolillo, Pietro Palermo, Mauro Contini, Marco Confalonieri, Pantaleo Giannuzzi, Andrea Passantino, Livio Dei Cas, Massimo F. Piepoli, Claudio Passino

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Objectives: 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. Background: HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty. Methods: Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041 days (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. Results: 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 1 year, 0.789 (0.750-0.828) at 2 years, 0.762 (0.726-0.799) at 3 years and 0.760 (0.724-0.796) at 4 years. Conclusions: 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.

Original languageEnglish
Pages (from-to)2710-2718
Number of pages9
JournalInternational Journal of Cardiology
Volume167
Issue number6
DOIs
Publication statusPublished - 2013

Fingerprint

Systolic Heart Failure
Exercise Test
Area Under Curve
Heart Failure
Kidney
Oxygen Consumption
Multicenter Studies
Uncertainty
Heart Ventricles
Echocardiography
Hemoglobins
Regression Analysis
Exercise
Transplants
Population
prednylidene

Keywords

  • Heart failure
  • Oxygen consumption
  • Prognosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score : A multiparametric approach to heart failure prognosis. / Agostoni, Piergiuseppe; Corrà, Ugo; Cattadori, Gaia; Veglia, Fabrizio; La Gioia, Rocco; Scardovi, Angela B.; Emdin, Michele; Metra, Marco; Sinagra, Gianfranco; Limongelli, Giuseppe; Raimondo, Rossella; Re, Federica; Guazzi, Marco; Belardinelli, Romualdo; Parati, Gianfranco; Magrì, Damiano; Fiorentini, Cesare; Mezzani, Alessandro; Salvioni, Elisabetta; Scrutinio, Domenico; Ricci, Renato; Bettari, Luca; Di Lenarda, Andrea; Pastormerlo, Luigi E.; Pacileo, Giuseppe; Vaninetti, Raffaella; Apostolo, Anna; Iorio, Annamaria; Paolillo, Stefania; Palermo, Pietro; Contini, Mauro; Confalonieri, Marco; Giannuzzi, Pantaleo; Passantino, Andrea; Cas, Livio Dei; Piepoli, Massimo F.; Passino, Claudio.

In: International Journal of Cardiology, Vol. 167, No. 6, 2013, p. 2710-2718.

Research output: Contribution to journalArticle

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 2013, 'Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: A multiparametric approach to heart failure prognosis', International Journal of Cardiology, vol. 167, no. 6, pp. 2710-2718. https://doi.org/10.1016/j.ijcard.2012.06.113
Agostoni, Piergiuseppe ; Corrà, Ugo ; Cattadori, Gaia ; Veglia, Fabrizio ; La Gioia, Rocco ; Scardovi, Angela B. ; Emdin, Michele ; Metra, Marco ; Sinagra, Gianfranco ; Limongelli, Giuseppe ; Raimondo, Rossella ; Re, Federica ; Guazzi, Marco ; Belardinelli, Romualdo ; Parati, Gianfranco ; Magrì, Damiano ; Fiorentini, Cesare ; Mezzani, Alessandro ; Salvioni, Elisabetta ; Scrutinio, Domenico ; Ricci, Renato ; Bettari, Luca ; Di Lenarda, Andrea ; Pastormerlo, Luigi E. ; Pacileo, Giuseppe ; Vaninetti, Raffaella ; Apostolo, Anna ; Iorio, Annamaria ; Paolillo, Stefania ; Palermo, Pietro ; Contini, Mauro ; Confalonieri, Marco ; Giannuzzi, Pantaleo ; Passantino, Andrea ; Cas, Livio Dei ; Piepoli, Massimo F. ; Passino, Claudio. / Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score : A multiparametric approach to heart failure prognosis. In: International Journal of Cardiology. 2013 ; Vol. 167, No. 6. pp. 2710-2718.
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title = "Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score: A multiparametric approach to heart failure prognosis",
abstract = "Objectives: 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. Background: HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty. Methods: Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041 days (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. Results: 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 1 year, 0.789 (0.750-0.828) at 2 years, 0.762 (0.726-0.799) at 3 years and 0.760 (0.724-0.796) at 4 years. Conclusions: 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.",
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author = "Piergiuseppe Agostoni and Ugo Corr{\`a} and Gaia Cattadori and Fabrizio Veglia and {La Gioia}, Rocco and Scardovi, {Angela B.} and Michele Emdin and Marco Metra and Gianfranco Sinagra and Giuseppe Limongelli and Rossella Raimondo and Federica Re and Marco Guazzi and Romualdo Belardinelli and Gianfranco Parati and Damiano Magr{\`i} and Cesare Fiorentini and Alessandro Mezzani and Elisabetta Salvioni and Domenico Scrutinio and Renato Ricci and Luca Bettari and {Di Lenarda}, Andrea and Pastormerlo, {Luigi E.} and Giuseppe Pacileo and Raffaella Vaninetti and Anna Apostolo and Annamaria Iorio and Stefania Paolillo and Pietro Palermo and Mauro Contini and Marco Confalonieri and Pantaleo Giannuzzi and Andrea Passantino and Cas, {Livio Dei} and Piepoli, {Massimo F.} and Claudio Passino",
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T1 - Metabolic exercise test data combined with cardiac and kidney indexes, the MECKI score

T2 - A multiparametric approach to heart failure prognosis

AU - Agostoni, Piergiuseppe

AU - Corrà, Ugo

AU - Cattadori, Gaia

AU - Veglia, Fabrizio

AU - La Gioia, Rocco

AU - Scardovi, Angela B.

AU - Emdin, Michele

AU - Metra, Marco

AU - Sinagra, Gianfranco

AU - Limongelli, Giuseppe

AU - Raimondo, Rossella

AU - Re, Federica

AU - Guazzi, Marco

AU - Belardinelli, Romualdo

AU - Parati, Gianfranco

AU - Magrì, Damiano

AU - Fiorentini, Cesare

AU - Mezzani, Alessandro

AU - Salvioni, Elisabetta

AU - Scrutinio, Domenico

AU - Ricci, Renato

AU - Bettari, Luca

AU - Di Lenarda, Andrea

AU - Pastormerlo, Luigi E.

AU - Pacileo, Giuseppe

AU - Vaninetti, Raffaella

AU - Apostolo, Anna

AU - Iorio, Annamaria

AU - Paolillo, Stefania

AU - Palermo, Pietro

AU - Contini, Mauro

AU - Confalonieri, Marco

AU - Giannuzzi, Pantaleo

AU - Passantino, Andrea

AU - Cas, Livio Dei

AU - Piepoli, Massimo F.

AU - Passino, Claudio

PY - 2013

Y1 - 2013

N2 - Objectives: 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. Background: HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty. Methods: Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041 days (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. Results: 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 1 year, 0.789 (0.750-0.828) at 2 years, 0.762 (0.726-0.799) at 3 years and 0.760 (0.724-0.796) at 4 years. Conclusions: 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.

AB - Objectives: 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. Background: HF prognostication is a challenging medical judgment, constrained by a magnitude of uncertainty. Methods: Our risk model was derived from a cohort of 2716 systolic HF patients followed in 13 Italian centers. Median follow up was 1041 days (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. Results: 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 1 year, 0.789 (0.750-0.828) at 2 years, 0.762 (0.726-0.799) at 3 years and 0.760 (0.724-0.796) at 4 years. Conclusions: 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.

KW - Heart failure

KW - Oxygen consumption

KW - Prognosis

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