MECKI score thresholds for heart transplantation referral of ambulatory heart failure patients.
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Agostoni Piergiuseppe, Galotta Arianna, Salvioni Elisabetta, Mapelli Massimo, Emdin Michele, Piepoli Massimo, Palazzuoli Alberto, Sinagra Gianfranco, Magrì Damiano, Paolillo Stefania, Passantino Andrea, Campodonico Jeness, Corrà Ugo, Raimondo Rosa, Cittadini Antonio, Iorio Annamaria, Salzano Andrea, Badagliacca Roberto, Senni Michele, Filardi Pasquale Perrone, Correale Michele, Perna Enrico, Metra Marco, Vignati Carlo, Contini Mauro, Baracchini Nikita, Cattadori Gaia, Guazzi Marco, Limongelli Giuseppe, Parati Gianfranco, Pezzuto Beatrice, Willixhofer Robin, Palermo Pietro, Apostolo Anna, Matassini Maria Vittoria, Bandera Francesco, Bussotti Maurizio, Re Federica, Scardovi Angela B, Sciomer Susanna, Girola Davide, Passino Claudio, La Valle Franco, Puttini Fiorella, Adamo Luigi
Аннотация
METHODS: Consecutive ambulatory HF patients enrolled in MECKI score programme between January 2010 and January 2022 were evaluated. Primary endpoint was a composite of cardiovascular death, HTX, or left ventricular assist device implantation. Heart transplant survival data were obtained from the International Society of Heart and Lung Transplantation registry updated through 2023. To identify the MECKI score threshold beyond which prognosis is worse than that of HTX recipients, patients were stratified by deciles of MECKI score.
RESULTS: We analysed 3865 HF patients (mean age 62.4 ± 12.6 years). Peak VO₂ was 58.2 ± 18.3% predicted; VE/VCO₂ slope 33.2 ± 8.2, haemoglobin 13.5 ± 1.7 g/dL, Na⁺ 139 ± 3 mmol/L, LVEF 33.7 ± 10.4%, and eGFR 73 ± 26 mL/min/1.73 m². Periodic breathing occurred in 15.8% of patients. At 5 years, mean survival was 83.7%.The average 5-year survival of HTX recipients (71.2%) lies between the eighth and ninth MECKI score deciles suggesting a MECKI score value ≥0.1368 as the proper cut-off for HTX listing.
CONCLUSION: MECKI score ≥0.1368 may warrant HTX listing, while lower scores support clinical deferral.