Author:
Grilli Giulia,Salvioni Elisabetta,Moscucci Federica,Bonomi Alice,Sinagra Gianfranco,Schaeffer Michele,Campodonico Jeness,Mapelli Massimo,Rossi Maddalena,Carriere Cosimo,Emdin Michele,Piepoli Massimo,Paolillo Stefania,Senni Michele,Passino Claudio,Apostolo Anna,Re Federica,Santolamazza Caterina,Magrì Damiano,Lombardi Carlo M.,Corrà Ugo,Raimondo Rosa,Cittadini Antonio,Iorio Annamaria,Salzano Andrea,Lagioia Rocco,Vignati Carlo,Badagliacca Roberto,Passantino Andrea,Filardi Pasquale Perrone,Correale Michele,Perna Enrico,Girola Davide,Metra Marco,Cattadori Gaia,Guazzi Marco,Limongelli Giuseppe,Parati Gianfranco,De Martino Fabiana,Matassini Maria Vittoria,Bandera Francesco,Bussotti Maurizio,Scardovi Angela Beatrice,Sciomer Susanna,Agostoni Piergiuseppe,
Abstract
BackgroundA sex-based evaluation of prognosis in heart failure (HF) is lacking.Methods and resultsWe analyzed the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score registry, which includes HF with reduced ejection fraction (HFrEF) patients. A cross-validation procedure was performed to estimate weights separately for men and women of all MECKI score parameters: left ventricular ejection fraction (LVEF), hemoglobin, kidney function assessed by Modification of Diet in Renal Disease, blood sodium level, ventilation vs. carbon dioxide production slope, and peak oxygen consumption (peakVO2). The primary outcomes were the composite of all-cause mortality, urgent heart transplant, and implant of a left ventricle assist device. The difference in predictive ability between the native and sex recalibrated MECKI (S-MECKI) was calculated using a receiver operating characteristic (ROC) curve at 2 years and a calibration plot. We retrospectively analyzed 7,900 HFrEF patients included in the MECKI score registry (mean age 61 ± 13 years, 6,456 men/1,444 women, mean LVEF 33% ± 10%, mean peakVO2 56.2% ± 17.6% of predicted) with a median follow-up of 4.05 years (range 1.72–7.47). Our results revealed an unadjusted risk of events that was doubled in men compared to women (9.7 vs. 4.1) and a significant difference in weight between the sexes of most of the parameters included in the MECKI score. S-MECKI showed improved risk classification and accuracy (area under the ROC curve: 0.7893 vs. 0.7799, p = 0.02) due to prognostication improvement in the high-risk settings in both sexes (MECKI score >10 in men and >5 in women).ConclusionsS-MECKI, i.e., the recalibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.