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

Ugo Corrà, Piergiuseppe Agostoni, Andrea Giordano, Gaia Cattadori, Elisa Battaia, Rocco La Gioia, Angela B. Scardovi, Michele Emdin, Marco Metra, Gianfranco Sinagra, Giuseppe Limongelli, Rosa Raimondo, Federica Re, Marco Guazzi, Romualdo Belardinelli, Gianfranco Parati, Damiano Magrì, Cesare Fiorentini, Mariantonietta Cicoira, Elisabetta SalvioniMarta Giovannardi, Fabrizio Veglia, Alessandro Mezzani, Domenico Scrutinio, Andrea Di Lenarda, Roberto Ricci, Anna Apostolo, Anna Maria Iorio, Stefania Paolillo, Pietro Palermo, Mauro Contini, Corrado Vassanelli, Claudio Passino, Pantaleo Giannuzzi, Massimo F. Piepoli

Research output: Contribution to journalArticlepeer-review


Background 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. Objectives MECKI score must be generalizable to be considered useful: therefore, its performance was validated in a new sequence of HF patients. Methods 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. Results 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. Conclusions MECKI score preserves its predictive ability in a HF population at a lower risk.

Original languageEnglish
Pages (from-to)1067-1072
Number of pages6
JournalInternational Journal of Cardiology
Publication statusPublished - Jan 15 2016


  • Heart failure
  • Prognosis, score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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