Associazione Nazionale Medici Cardiologi Ospedalieri



Prognostic performance of MECKI score in heart failure patients with non-valvular atrial fibrillation treated with Edoxaban

Mapelli Massimo Mapelli Milano(Milano) – Centro Cardiologico Monzino, IRCCS | Mattavelli Irene Milano(Milano) – Centro Cardiologico Monzino, IRCCS | Salvioni Elisabetta Milano(Milano) – Centro Cardiologico Monzino, IRCCS

Background: Risk stratification in heart failure (HF) is crucial for clinical and therapeutic management. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score is a validated HF model to assess the risk of cardiovascular mortality, urgent heart transplantation and Left Ventricle Assist Device implantation at 2 years. The score integrates cardiopulmonary exercise test (CPET) parameters with hemoglobin, serum sodium, kidney function (MDRD), left ventricle ejection fraction, peak oxygen consumption [% pred] and VE/VCO2 slope.

Non-valvular atrial fibrillation (NVAF) is a common feature in HF patients. Recently, direct oral anticoagulants (DOACs) were introduced as an alternative VKAs and have now emerged as the preferred choice. Aim of the study was to assess the reliability of the prognostic evaluation by MECKI score also in HF patients treated with Edoxaban for NVAF.

Methods: We prospectively enrolled consecutive outpatients with HF and NVAF treated with Edoxaban. Each patient underwent a maximal ramp-protocol CPET and a blood sampling for complete blood count, serum electrolytes and renal function. This population was matched for age and sex by propensity score with a retrospective group of HF patients with NVAF treated with VKA belonging to the MECKI score registry.

Results: 83 patients with HF and NVAF treated with Edoxaban were enrolled. Median follow up was 814[608-1052] days. A control population was identified in the multicentric MECKI score database (n=7800) by selecting all consecutive patients with HF and NVAF treated with VKA (n=844). The population was propensity score-matched for age and sex. Table 1 compares the main population characteristics. MECKI score performs equally well in predicting the outcome in the two groups (AUC matched population 0.73193, AUC Edoxaban group 0.6557, p=ns) (Figure 1).

Conclusion: MECKI score power was confirmed also in the new population treated with Edoxaban with a slightly higher performance respect to patients treated with VKA.