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Recalibrating the MECKI score in a Portuguese cohort of patients with Heart Failure
Session:
CO 08 - Insuficiência cardíaca crónica
Speaker:
Sérgio Maltês
Congress:
CPC 2021
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
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Authors:
Sérgio Maltês; Pedro Freitas; Bruno ml Rocha; Gonçalo jl Cunha; Catarina Brízido; Christopher Strong; António Tralhão; António Ventosa; António m Ferreira; Carlos mt Aguiar; Miguel Mendes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Background</span></u><span style="color:black">: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Recalibration is often needed when applying new models to external populations where patient characteristics might be different. Risk assessment in the setting of advanced heart failure (HF) is particularly troublesome since critical decisions are often based on these models. The purpose of this study was to assess the performance of 4 different HF prognostic scores, and recalibrate the risk predictions of the best one in a Portuguese cohort. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Methodology</span></u><span style="color:black">: This is a single-center retrospective cohort of HF patients with reduced left ventricle ejection fraction (LVEF < 40%) undergoing cardiopulmonary exercise testing (CPET) between 2003 and 2018. Patients were excluded if they performed a suboptimal CPET (defined by a respiratory exchange ratio <1.10). The Heart Failure Survival Score (HFSS), Seattle Heart </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Failure Model (SHFM), Meta-analysis Global Group in Chronic Heart Failure (MAGGIC), and Metabolic Exercise Cardiac Kidney Index (MECKI) were assessed for the discrimination ability (area under the ROC curve) to predict a combined endpoint of cardiovascular death or urgent Heart Transplantation (HTx) at 2-years. Calibration analysis was conducted, and logistical recalibration performed as needed.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Results</span></u><span style="color:black">: A total of 251 patients (mean age 57 ± 12 years; 79% male; 53% with ischemic HF) were included. Mean LVEF was 28 ± 6%. Over a 2-year follow-up period after CPET, 24 cardiovascular deaths occurred and 16 patients received an urgent HTx. There were no urgent LVADs implanted used in our population. The original MECKI score showed the best discrimination ability to predict 2-year risk of cardiovascular death or urgent HTx (AUC 0.83; 95%CI 0.76 to 0.89; <em>P </em>< 0.001) – see figure panel A. However, the original MECKI score tended to overestimate event occurence (overall miscalibration of 16.1%), especially in the highest risk subgroups – see figure panel B. After recalibration – see figure panel C – miscalibration diminished to 0.2%, allowing a more accurate prediction of CV death or urgent HTx at 2-years.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="color:black">Conclusion</span></u><span style="color:black">: The MECKI score showed the best discriminative ability to predict CV death or urgent HTx at 2-years, but significantly overestimated the risk of events. This overestimation was corrected by recalibrating the model for our population. The newly calibrated MECKI score might prove useful for guiding decisions in Portuguese patients with advanced HF.</span></span></span></p>
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