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.

<p>Abstract</p> <p><strong><span>Background:</span></strong><span> A sex-based evaluation of prognosis in heart failure (HF) is lacking.<span>&nbsp; </span></span></p> <p><strong><span>Methods and results: </span></strong><span>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 dioxideproduction slope, and peak oxygen consumption (peakVO₂). The primary outcomes were the composite of all-cause mortality, urgent heart transplant and LVAD implant. </span><span>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.</span></p> <p><span>We retrospectively analyzed 7900 HFrEF patients included in the MECKI score registry (61&plusmn;13 years, 6456 M/ 1444 F, LVEF 33&plusmn;10 %, peakVO₂ </span><span>56.2&plusmn;17.6 % of predicted</span><span>) 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</span><span> 0.7893 vs. 0.7799, p=0.02 due to prognostication improvement </span><span>in the high-risk settings in both sexes (MECKI score &gt;10 in males and &gt;5 in females).</span></p> <p><strong><span>Conclusions: </span></strong><span>S-MECKI,<strong> </strong>i.e. the re-calibrated MECKI according to sex-specific differences,</span><span> constitutes a further step in the prognostic assessment of patients with severe HFrEF.</span></p>