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

被引：192

作者：

Agostoni, Piergiuseppe ^{[1
,2
,3
]}

Corra, Ugo ^{[4
]}

Cattadori, Gaia ^{[1
]}

Veglia, Fabrizio ^{[1
]}

La Gioia, Rocco ^{[5
]}

Scardovi, Angela B. ^{[6
]}

Emdin, Michele ^{[7
]}

Metra, Marco ^{[8
]}

Sinagra, Gianfranco ^{[9
,10
]}

Limongelli, Giuseppe ^{[11
]}

Raimondo, Rossella ^{[12
]}

Re, Federica ^{[13
,14
]}

Guazzi, Marco ^{[15
]}

Belardinelli, Romualdo ^{[16
]}

Parati, Gianfranco ^{[17
,18
]}

Magri, Damiano ^{[19
]}

Fiorentini, Cesare ^{[1
,2
]}

Mezzani, Alessandro ^{[4
]}

Salvioni, Elisabetta ^{[1
]}

Scrutinio, Domenico ^{[5
]}

Ricci, Renato

Bettari, Luca ^{[8
]}

Di Lenarda, Andrea ^{[20
]}

Pastormerlo, Luigi E. ^{[7
]}

Pacileo, Giuseppe ^{[11
]}

Vaninetti, Raffaella ^{[12
]}

Apostolo, Anna ^{[1
]}

Iorio, AnnaMaria ^{[1
]}

Paolillo, Stefania ^{[1
]}

Palermo, Pietro ^{[1
]}

Contini, Mauro ^{[1
]}

Confalonieri, Marco ^{[9
,10
]}

Giannuzzi, Pantaleo ^{[4
]}

Passantino, Andrea ^{[5
]}

Dei Cas, Livio ^{[8
]}

Piepoli, Massimo F. ^{[21
]}

Passino, Claudio ^{[7
,22
]}

机构：

[1] IRCCS, Ctr Cardiol Monzino, I-20138 Milan, Italy

[2] Univ Milan, Dipartimento Sci Cardiovasc, Milan, Italy

[3] Univ Washington, Dept Resp & Crit Care Med, Seattle, WA 98195 USA

[4] Ist Sci Veruno, IRCCS, Fdn Salvatore Maugeri, Div Cardiol Riabilitat, Veruno, Italy

[5] Ist Sci Veruno, IRCCS, S Maugeri Fdn, Div Cardiol, Bari, Italy

[6] Osped S Spirito, UOC Cardiol, Rome, Italy

[7] Fdn Gabriele Monasterio, CNR Reg Toscana, Pisa, Italy

[8] Univ Civil Hosp, Brescia, Italy

[9] Osped Riuniti, Cardiovasc Dept, Trieste, Italy

[10] Univ Trieste, Trieste, Italy

[11] Seconda Univ Napoli, Osped Monaldi Azienda Colli, Cardiol SUN, Naples, Italy

[12] Ist Sci Tradate, IRCCS, Fdn Salvatore Maugeri, Dipartimento Med & Riabilitaz Cardioresp Unita Ca, Tradate, Italy

[13] St Camillo Forlanini Hosp, Cardiac Arrhythmia Ctr, Div Cardiol, Rome, Italy

[14] St Camillo Forlanini Hosp, Cardiomyopathies Unit, Rome, Italy

[15] Univ Milan, IRCCS Policlin San Donato, Heart Failure Unit, Milan, Italy

[16] Azienda Osped Riuniti, Ancona, Italy

[17] Univ Milano Bicocca, Dept Clin Med & Prevent, Milan, Italy

[18] S Luca Hosp, Ist Auxol Italiano, Dept Cardiol, Milan, Italy

[19] Univ Roma La Sapienza, Dipartimento Med Clin & Mol, Rome, Italy

[20] Azienda & Serv Sanitari 1, Ctr Cardiovasc, Trieste, Italy

[21] G Saliceto Hosp, UOC Cardiol, Piacenza, Italy

[22] Scuola Super Sant Anna, Pisa, Italy

来源：

INTERNATIONAL JOURNAL OF CARDIOLOGY | 2013年 / 167卷 / 06期

关键词：

Heart failure; Prognosis; Oxygen consumption; PEAK OXYGEN-CONSUMPTION; LEFT-VENTRICULAR DYSFUNCTION; RISK STRATIFICATION; AMBULATORY PATIENTS; SURVIVAL SCORE; VENTILATORY EFFICIENCY; RANDOMIZED-TRIAL; MORTALITY; VALIDATION; PREDICTOR;

D O I：

10.1016/j.ijcard.2012.06.113

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

引用

页码：2710 / 2718

页数：9

共 54 条

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