Re-Evaluation of MECKI Score Valuable in Identifying High-Risk Patients With HF

Re-evaluation of MECKI score during follow-up for patients with HFrEF can help identify individuals at high risk for morbidity and mortality.

In patients with heart failure with reduced ejection fraction (HFrEF), re-evaluation of the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score during follow-up is valuable, as it permits the recognition of individuals at high risk for morbidity and mortality, according to findings from a multicenter, retrospective study published in the International Journal of Cardiology.

With high rates of mortality and rehospitalization reported among patients with HF, the precise, individually tailored prognostic estimation of these rates is of key importance for establishing appropriate treatment and patient follow-up strategies. Risk stratification among patients with HF remains challenging, however, because of the complexity of HF pathophysiology, the presence of comorbidities, and the limited access to expensive pharmacologic and device therapies, as well as to such sophisticated analyses as cardiac magnetic resonance imaging and genetic testing. Cardiopulmonary exercise testing is an easy-to-perform, inexpensive, accurate, well-known tool for risk stratification in individuals with HF.

Researchers sought to examine whether time-related changes in the MECKI score were associated with added prognostic value. The study endpoint included the following:

  • Combination of death from any cause
  • Hospitalization for HF
  • Hospitalization for cardiovascular causes other than HF
  • Implantation of left ventricular assist device
  • Urgent heart transplantation

The study included a total of 660 participants who received MECKI re-evaluation at least 6 months apart. According to the difference between the MECKI II and MECKI I scores, the study population was divided into 2 groups, patients who presented with a decrease in score (Δ MECKI <0), which represents clinical improvement (n=366), and patients who presented with an increase in score, which represents clinical deterioration (n=294).

The results of our study confirm the value of the MECKI score in the prognostic assessment of patients with HFrEF.

The average time between MECKI I and MECKI II score determination was 2.02±1.18 years, whereas the median value was 2.03 years (range, 1.34-4.00 years). Overall, 81% of the patients were men and 47% had an ischemic etiology of HF. The mean participant age at MECKI I score evaluation was 60.7±12.2 years.

Results of the study showed that the 366 participants with improved MECKI scores exhibited a significantly better prognosis compared with the 294 individuals with worsened MECKI scores (P <.0001). At the initial assessment, the 2 groups differed according to left ventricular ejection fraction, ventilation to carbon dioxide productionslope, and serum sodium concentration. At the second assessment, however, the 2 groups differed in all of the 6 parameters taken into consideration in the score. In the individuals who reported improved MECKI scores, improvements were reported in all of the 6 MECKI components except for hemoglobin level. In contrast, in the participants who reported worsening MECKI scores, all of the 6 MECKI parameters worsened.

Some limitations of the analysis include the design, which was retrospective, therefore definitive conclusions cannot be derived. Additionally, the generalizability of the study may be limited.

“The results of our study confirm the value of the MECKI score in the prognostic assessment of patients with HFrEF,” the researchers wrote. “This could help physicians to improve tailored patients’ follow-up strategies, risk stratification, and resources allocation.”


Pezzuto B, Piepoli M, Galotta A, et al. The importance of re-evaluating the risk score in heart failure patients: an analysis from the Metabolic Exercise Cardiac Kidney Indexes (MECKI) score database. Int J Cardiol. Published online January 26, 2023. doi:10.1016/j.ijcard.2023.01.069