A matter of sex: persistent predictive value of MECKI score prognostic power in females and males with heart failure and reduced ejection fraction. A multicenter study.

Abstract

Background: A sex-based evaluation of prognosis in heart failure (HF) is lacking. 

Methods and results: We analyzed the MECKI score registry which includes HF with reduced ejection fraction (HFrEF) patients. A cross-validation procedure was performed to estimate weights separately for males and females of all MECKI score parameters: left ventricular ejection fraction (LVEF), hemoglobin, kidney function assessed by MDRD, 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 LVAD implant. The difference in predictive ability between the native and sex re-calibrated MECKI (S-MECKI) was calculated with the ROC curve at 2-years and a calibration plot.

We retrospectively analyzed 7900 HFrEF patients included in the MECKI score registry (61±13 years, 6456 M/ 1444 F, LVEF 33±10 %, peakVO₂ 56.2±17.6 % of predicted) with a median follow up of 4.05 years [1.72-7.47]. Our results revealed an unadjusted risk of events doubled in males compared to females (9.7 vs. 4.1) and a significant difference in weight between sexes of most of the parameters included in the MECKI score. S-MECKI showed improved risk classification and accuracy (AUC 0.7893 vs. 0.7799, p=0.02 due to prognostication improvement in the high-risk settings in both sexes (MECKI score >10 in males and >5 in females).

Conclusions: S-MECKI, i.e. the re-calibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.