MECKI score thresholds for heart transplantation referral of ambulatory heart failure patients
Year: 2026
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: In heart failure (HF) patients, guidelines recommend scores for assessing outcomes and heart transplant (HTX) eligibility. However, scores use remains limited and cut-off values for HTX listing not well established.Among the available tools, MECKI score is easy to calculate and likely offers the best prognostic accuracy. Compare MECKI score-based survival with that of HTX recipients and identify a MECKI threshold above which survival is inferior to that of HTX recipients at 5-year. METHODS: Consecutive ambulatory HF patients enrolled in MECKI score programme between January 2010 and January 2022 were evaluated. Primary endpoint was a composite of cardiovascular death, HTX, or left ventricular assist device implantation. Heart transplant survival data were obtained from the International Society of Heart and Lung Transplantation registry updated through 2023. To identify the MECKI score threshold beyond which prognosis is worse than that of HTX recipients, patients were stratified by deciles of MECKI score. RESULTS: We analysed 3865 HF patients (mean age 62.4 ± 12.6 years). Peak VO₂ was 58.2 ± 18.3% predicted; VE/VCO₂ slope 33.2 ± 8.2, haemoglobin 13.5 ± 1.7 g/dL, Na⁺ 139 ± 3 mmol/L, LVEF 33.7 ± 10.4%, and eGFR 73 ± 26 mL/min/1.73 m². Periodic breathing occurred in 15.8% of patients. At 5 years, mean survival was 83.7%.The average 5-year survival of HTX recipients (71.2%) lies between the eighth and ninth MECKI score deciles suggesting a MECKI score value ≥0.1368 as the proper cut-off for HTX listing. CONCLUSION: MECKI score ≥0.1368 may warrant HTX listing, while lower scores support clinical deferral.
Source: ESC Heart Failure
Authors: Piergiuseppe Agostoni, Arianna Galotta, Elisabetta Salvioni, Massimo Mapelli, Michele Emdin, Massimo Piepoli, Alberto Palazzuoli, Gianfranco Sinagra, Damiano Magrì, Stefania Paolillo, Andrea Passantino, Jeness Campodonico, Ugo Corrà, Rosa Raimondo, Antonio Cittadini, Annamaria Iorio, Andrea Salzano, Roberto Badagliacca, Michele Senni, Pasquale Perrone Filardi, Michele Correale, Enrico Perna, Marco Metra, Carlo Vignati, Mauro Contini, Nikita Baracchini, Gaia Cattadori, Marco Guazzi, Giuseppe Limongelli, Gianfranco Parati, Beatrice Pezzuto, Robin Willixhofer, Pietro Palermo, Anna Apostolo, Maria Vittoria Matassini, Francesco Bandera, Maurizio Bussotti, Federica Re, Angela B Scardovi, Susanna Sciomer, Davide Girola, Claudio Passino, Franco La Valle, Fiorella Puttini, Luigi Adamo
Institutions: University of Milan, Centro Cardiologico Monzino, Scuola Superiore Sant'Anna, Fondazione Toscana Gabriele Monasterio, IRCCS Policlinico San Donato, University of Siena, Ospedale Santa Maria alle Scotte, Azienda sanitaria universitaria Giuliano Isontina, Azienda Ospedaliera Sant'Andrea, Sapienza University of Rome, University of Naples Federico II, Istituti Clinici Scientifici Maugeri, IRCCS Ospedale San Raffaele, Ospedale Papa Giovanni XXIII, Ospedale Antonio Cardarelli, University of Foggia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, University of Brescia, MultiMedica, Ospedale San Paolo, University of Campania "Luigi Vanvitelli", Ospedale Monaldi, IRCCS Istituto Auxologico Italiano, University of Milano-Bicocca, Azienda Ospedaliero-Universitaria delle Marche, Azienda Ospedaliera San Camillo-Forlanini, Ospedale di Santo Spirito, Instituto Médico Río Cuarto, Centro Médico Sanitas Murcia, Istituto Superiore di Sanità, University of Rome Tor Vergata, Policlinico Tor Vergata, Johns Hopkins University, Johns Hopkins Medicine
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,850
Funder: Ministero della Salute
OpenAlex ID: W7119523739