Mallepally A; School of Medicine, Richmond, Virginia, USA.
Dandamudi K; Kaye MG; Zavar T; Parsons B; Krishnamurthy S;
Patel H; Arena R; Canada JM; Trankle CR

Physiological Reports. 14(3):e70770, 2026 Feb.

The Metabolic Exercise test data combined with Cardiac and Kidney Indexes
(MECKI) score has demonstrated prognostic utility in European and Asian
cohorts with heart failure with reduced ejection fraction (HFrEF). We
sought to evaluate its performance in an American cohort. We
retrospectively identified patients who underwent cardiopulmonary exercise
testing (CPX) at our institution in 2022-2024 with data to calculate the
MECKI and CPX Risk scores. The primary endpoint was a composite of death,
heart failure admission, heart transplantation, or ventricular assist
device. Survival analysis was assessed via Kaplan-Meier curves and
log-rank test, with ROC curves for comparison. Overall, 803 patients met
criteria, with 451 (56%) female, 228 (28%) Black race, and median body
mass index 29.4 (25.0-34.2) kg/m2. Pre-existing HFrEF was present in 187
(23%) patients. 719 (90%), 41 (5%), and 43 (5%) patients achieved MECKI
scores <10%, 10%-20%, and >=20%, respectively, with stepwise increases in
2-year risk of primary endpoints (log-rank chi2 = 196.0, p < 0.001). ROC
curves demonstrated better performance of MECKI scores compared to CPX
Risk scores. Events were similarly predicted in patients with HFrEF, with
similar performances between the two scores. In conclusion, in a mixed
American cohort the MECKI score demonstrated robust performance in
predicting event-free survival.