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

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.

研究目的：

心脏衰竭（HF）的风险分层对于临床及治疗管理至关重要。多参数方法是目前最佳的预后分层手段。2012年，代谢运动测试数据与心脏及肾脏指数（MECKI）评分相结合，被提出用于评估心血管死亡率及紧急心脏移植的风险。本研究旨在比较MECKI评分与心脏衰竭生存评分（HFSS）以及西雅图心脏衰竭模型（SHFM）在大规模、多中心的心脏衰竭患者队列中，对降低射血分数患者的预后准确性的优劣。

研究方法与结果：

我们收集了6112例心脏衰竭患者的数据，并比较了MECKI评分、HFSS和SHFM在2年和4年随访时，对心血管死亡、紧急心脏移植或心室辅助装置植入的复合终点的预后准确性。患者的中位随访时间为3.67年，记录了931例心血管死亡、160例紧急心脏移植和12例心室辅助装置植入。在2年随访时，MECKI评分的预后准确性显著优于SHFM（曲线下面积AUC 0.739）和HFSS（AUC 0.723），这一关系在4年随访时也得到了证实（AUC分别为0.764、0.725和0.720）。

结论：

在本队列中，对于处于稳定临床状态的心脏衰竭患者，MECKI评分在2年和4年随访时的预后准确性均优于HFSS和SHFM。MECKI评分可能有助于优化资源配置和改善患者预后，但仍需前瞻性评估。