Multiparametric prognostic scores in chronic heart failure with reduced ejection fraction: a long-term comparison

Piergiuseppe Agostoni, Stefania Paolillo, Massimo Mapelli, Piero Gentile, Elisabetta Salvioni, Fabrizio Veglia, Alice Bonomi, Ugo Corrà, Rocco Lagioia, Giuseppe Limongelli, Gianfranco Sinagra, Gaia Cattadori, Angela B Scardovi, Marco Metra, Valentina Carubelli, Domenico Scrutinio, Rosa Raimondo, Michele Emdin, Massimo Piepoli, Damiano MagrìGianfranco Parati, Sergio Caravita, Federica Re, Mariantonietta Cicoira, Chiara Minà, Michele Correale, Maria Frigerio, Maurizio Bussotti, Fabrizio Oliva, Elisa Battaia, Romualdo Belardinelli, Alessandro Mezzani, Luigi Pastormerlo, Marco Guazzi, Roberto Badagliacca, Andrea Di Lenarda, Claudio Passino, Susanna Sciomer, Elena Zambon, Giuseppe Pacileo, Roberto Ricci, Anna Apostolo, Pietro Palermo, Mauro Contini, Francesco Clemenza, Giovanni Marchese, Paola Gargiulo, Simone Binno, Carlo Lombardi, Andrea Passantino, Pasquale Perrone Filardi

Research output: Contribution to journalArticlepeer-review


AIMS: Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. A multiparametric approach is the best method to stratify prognosis. In 2012, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was proposed to assess the risk of cardiovascular mortality and urgent heart transplantation. The aim of the present study was to compare the prognostic accuracy of MECKI score to that of HF Survival Score (HFSS) and Seattle HF Model (SHFM) in a large, multicentre cohort of HF patients with reduced ejection fraction.

METHODS AND RESULTS: We collected data on 6112 HF patients and compared the prognostic accuracy of MECKI score, HFSS, and SHFM at 2- and 4-year follow-up for the combined endpoint of cardiovascular death, urgent cardiac transplantation, or ventricular assist device implantation. Patients were followed up for a median of 3.67 years, and 931 cardiovascular deaths, 160 urgent heart transplantations, and 12 ventricular assist device implantations were recorded. At 2-year follow-up, the prognostic accuracy of MECKI score was significantly superior [area under the curve (AUC) 0.781] to that of SHFM (AUC 0.739) and HFSS (AUC 0.723), and this relationship was also confirmed at 4 years (AUC 0.764, 0.725, and 0.720, respectively).

CONCLUSION: In this cohort, the prognostic accuracy of the MECKI score was superior to that of HFSS and SHFM at 2- and 4-year follow-up in HF patients in stable clinical condition. The MECKI score may be useful to improve resource allocation and patient outcome, but prospective evaluation is needed.

Original languageEnglish
JournalEuropean Journal of Heart Failure
Publication statusPublished - 2018


  • Journal Article


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