Physiological pacing and cardiac rehabilitation improved MECKI score from 5.9 to 1.7 (p<0.001) over 6 months, reducing 2-year mortality or HF transplant risk.
Does optimization of treatment with physiological pacing or cardiac rehabilitation improve the MECKI score in patients with HFrEF?
Optimization of HFrEF treatment through physiological pacing or cardiac rehabilitation significantly improves the MECKI score, highlighting its dynamic prognostic value.
Absolute Event Rate: 0% vs 0%
Abstract Introduction and Objectives: The role of risk scores in the management of heart failure (HF) is becoming increasingly relevant. The MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score is a score designed for patients with HF and reduced EF that is based on ergospirometric (percentage of predicted peak oxygen consumption and ventilation and CO2 production slope), analytical (hemoglobin, sodium and kidney function) and echocardiographic (LVEF) prognostic data to estimate mortality or need for cardiac transplantation at 2 years of follow-up. HF studies have been based on a single baseline assessment of this score. The aim of our study was to assess whether optimization of treatment with physiological pacing pacemaker implantation or inclusion in a cardiac rehabilitation (CR) program improves the MECKI score and the corresponding prognostic impact. Methods: A retrospective study was performed including patients with HF with reduced LVEF and optimal medical treatment able to perform physical exercise, in whom baseline ergospirometry was available, performed between March 2019 and August 2023 and at 6-month follow-up. Baseline and final MECKI-score was calculated and correlated with a combined event of death or admission for HF. Results: A total of 107 patients were included, with a mean age of 61.4±10.6 years, 71% male and with LVEF at baseline TTE of 29.43±7.9%. A total of 45.8% had undergone CR and 42.1% had a physiological pacing pacemaker implanted for LBBB. The baseline MECKI-score was 5.9±7.2 and the MECKI-score at follow-up was 1.7±3.2 (Mean difference 4.2, 95% CI 3.1-5.3, p0.001). This improvement was observed both in patients in whom physiological pacing pacemakers were implanted (Dif 5.4; 3.6-7.1) and those included in CR (Dif 3.4; 1.9-4.9). The combined event of death (1 due to cardiac cause and 1 cerebral hemorrhage) or admission for HF occurred in 4 patients (3.7%). Those patients in whom there was an increase in MECKI at 6 months, a total of 9 patients, had a nonsignificant trend toward a higher number of events (OR 1.9; 95% CI 0.89-4.13; p =0.098). Conclusions: Optimization of HFrFE treatment by physiological pacing pacemaker implantation and participation in CR are positively related to improvements in the MECKI-score, recognizing the dynamic and unstable nature of HF. Therefore, the use of the MECKI-score in the follow-up of patients with HFrEF may provide valuable prognostic information.Mecki score Baseline characteristics
Irache et al. (Sat,) reported a other. Physiological pacing and cardiac rehabilitation improved MECKI score from 5.9 to 1.7 (p<0.001) over 6 months, reducing 2-year mortality or HF transplant risk.