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Adamopoulos S, Miliopoulos D, Piotrowicz E, Snoek JA, Panagopoulou N, Nanas S, Niederseer D, Mazaheri R, Ma J, Chen Y, Popovic D, Seferovic P, Girola D, Corrà U, Coats AJS, Metra M, Rosano GMC, Volterrani M, Apostolo A, Campodonico J, Salvioni E, Agostoni P, Piepoli M. International validation of the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score in heart failure. Eur J Prev Cardiol 2023; 30:1371-1379. [PMID: 37288595 DOI: 10.1093/eurjpc/zwad191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/05/2023] [Accepted: 06/01/2023] [Indexed: 06/09/2023]
Abstract
AIMS Current European heart failure (HF) guidelines suggest the use of risk score: among them, the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has demonstrated to be one of the most accurate. However, the risk scores are still poorly implemented in clinical practice, also due to the lack of strong evidence regarding their external validation in different populations. Thus, the current study was designed as an external validation test of the MECKI score in an international multicentre setting. METHODS AND RESULTS The study cohort consisted of patients diagnosed with HF with reduced ejection fraction (HFrEF) across international centres (not Italian), retrospectively recruited. Collected data included demographics, HF aetiology, laboratory testing, electrocardiogram (ECG), echocardiographic findings, and cardiopulmonary exercise testing (CPET) results as described in the original MECKI score publication. A total of 1042 patients across 8 international centres (7 European and 1 Asian) were included and followed up from 1998 till 2019. Patients were divided according to the calculated MECKI scores into three subgroups: (i) MECKI score <10%, (ii) 10-20%, and (iii) ≥ 20%. Survival analysis comparison among the three MECKI score subgroups showed a worse prognosis in patients with higher MECKI score value: median event-free survival times were 4396 days for MECKI score <10%, 3457 days for 10-20%, and 1022 days for ≥20% (P < 0.0001). Receiver operating characteristic (ROC) curves and area under the ROC curves (AUC) were like those reported in the original internal validation studies. CONCLUSION In patients diagnosed with HFrEF, the power of the MECKI score was confirmed in terms of prognosis and risk stratification, supporting its implementation as advised by the HF guidelines.
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Affiliation(s)
- Stamatis Adamopoulos
- Heart Failure and Heart Transplant Units, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea, 176 74, Attica, Greece
| | - Dimitris Miliopoulos
- Heart Failure and Heart Transplant Units, Onassis Cardiac Surgery Centre, Leof. Andrea Siggrou 356, Kallithea, 176 74, Attica, Greece
| | - Ewa Piotrowicz
- Telecardiology Center, National Institute of Cardiology, Alpejska 42, 04-628 Warszawa, Poland
| | - Johan Aernout Snoek
- Department of Sports Medicine and Cardiology, Dokter Van Heesweg 2, 8025 AB Zwolle, Netherlands
| | - Niki Panagopoulou
- Department of Cardiology, 'Helena Venizelou' Hospital, Elenas Venizelou 2, Athina 115 21, Greece
| | - Serafim Nanas
- Department of ICU, 'Evangelismos' Hospital, Ipsilantou 45-47, Athina 106 76, Greece
| | - David Niederseer
- Department of Cardiology, University Heart Center Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Reza Mazaheri
- Department of Cardiology, University Heart Center Zurich, University of Zurich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Jing Ma
- Department of Cardiology, First Medical Center of PLA General Hospital, 28 Fuxing Road, 100853 Beijing, China
| | - Yundai Chen
- Department of Cardiology, Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Beijing, Cina, 100053
| | - Dejana Popovic
- Department of Cardiology, Clinical Center of Serbia, University Clinical Center of Serbia, Pasterova 2, 11000 BelgradE, Serbia
- Department of Cardiovascular Medicine, Mayo Clinic, 200 First street SW, Rochester, MN 55905, USA
| | - Petar Seferovic
- Department of Cardiology, Clinical Center of Serbia, University Clinical Center of Serbia, Pasterova 2, 11000 BelgradE, Serbia
| | - Davide Girola
- Capo Clinica, Clinica Hildebrand, Centro di riabilitazione Brissago, Via Crodolo 18, 6614 Brissago, Switzerland
| | - Ugo Corrà
- Istituti Clinici Maugeri, IRCCS, Via Revislate, 13 · 0322, Veruno, Italy
| | - Andrew J S Coats
- Office of the CEO, Heart Research Institute, 7 Eliza St, Newtown NSW 2042, Sydney, Australia
| | - Marco Metra
- Cardiology, University of Brescia, Piazza del Mercato, 15, 25121, Brescia, Italy
| | - Giuseppe M C Rosano
- Cardio-Pulmonary Department, IRCCS San Raffaele La Pisana, Via della Pisana, 235. 00163 Roma, Italy
| | - Maurizio Volterrani
- Cardio-Pulmonary Department, IRCCS San Raffaele La Pisana, Via della Pisana, 235. 00163 Roma, Italy
| | - Anna Apostolo
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milano, Italy
| | - Jeness Campodonico
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milano, Italy
| | - Elisabetta Salvioni
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milano, Italy
| | - Piergiuseppe Agostoni
- Heart Failure Unit, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milano, Italy
- Department of Clinical Sciences and Community Medicine, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy
| | - Massimo Piepoli
- Clinical Cardiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Via Festa del Perdono, 7, 20122 Milano, Italy
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Verwoert GC, de Vries ST, Bijsterveld N, Willems AR, Vd Borgh R, Jongman JK, Kemps HMC, Snoek JA, Rienks R, Jorstad HT. Return to sports after COVID-19: a position paper from the Dutch Sports Cardiology Section of the Netherlands Society of Cardiology. Neth Heart J 2020; 28:391-395. [PMID: 32662058 PMCID: PMC7357275 DOI: 10.1007/s12471-020-01469-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has led to preventive measures worldwide. With the decline of infection rates, less stringent restrictions for sports and exercise are being implemented. COVID-19 is associated with significant cardiovascular complications; however there are limited data on cardiovascular complications and long-term outcomes in both competitive (elite) athletes and highly active individuals. Based on different categories of disease severity (asymptomatic, regional/systemic symptoms, hospitalisation, myocardial damage, and/or myocarditis), in this point-of-view article we offer the (sports) cardiologist or sports physician in the Netherlands a practical guide to pre-participation screening, and diagnostic and management strategies in all athletes >16 years of age after COVID-19 infection.
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Affiliation(s)
- G C Verwoert
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands. .,Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - S T de Vries
- Department of Cardiology, Tjongerschans Hospital, Heerenveen, The Netherlands
| | - N Bijsterveld
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands.,Department of Cardiology, Flevo Hospital, Almere, The Netherlands
| | - A R Willems
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - R Vd Borgh
- Department of Cardiology, Laurentius Hospital, Roermond, The Netherlands
| | - J K Jongman
- Department of Cardiology, Wilhelmina Hospital, Assen, The Netherlands
| | - H M C Kemps
- Department of Cardiology, Maxima Medical Centre, Veldhoven, The Netherlands.,Department of Industrial Design, Technical University, Eindhoven, The Netherlands
| | - J A Snoek
- Department of Sports medicine, Isala, Zwolle, The Netherlands.,Isala Heart Centre, Zwolle, The Netherlands
| | - R Rienks
- Central Military Hospital, Utrecht, The Netherlands
| | - H T Jorstad
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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De Kluiver EP, Van Der Velde AE, Meindersma EP, Prins LF, Wilhelm M, Iliou MC, Pena Gil C, Gonzalez-Juanatey JR, Snoek JA, Kolkman E, Van't Hof AWJ, Prescott E. P1927A European randomised controlled trial for m-health guided cardiac rehabilitation in the elderly; results of the EU-CaRE RCT study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Knowledge about effectiveness of cardiac rehabilitation (CR) in the elderly is limited. Participation rates in supervised CR are consistently lower in the elderly and innovative interventions are needed. The EU has granted a CR study project; a randomised controlled trial conducted in 5 European countries, investigating the effectiveness of mobile telemonitoring guided CR (mCR) in elderly cardiac patients who declined regular CR.
Methods
Patients ≥65 years with indication for CR who declined regular CR were eligible for inclusion. Patients were randomised between regular care (without CR) and a 6-month mCR programme: dedicated programmed smartphone, heartrate monitoring (target HR zones) and coaching. The primary endpoint is the difference in VO2peak between 6-months follow-up and baseline.
Results
Between 2015 and 2018 179 patients were included. Baseline characteristics between groups (table 1) did not differ significantly, except for hypertension. The difference in VO2peak was significantly better in the mCR group (table 1). After correction (mixed linear model) for baseline VO2 peak (fixed factor) and centre (random factor) this difference remained significant. Mean number of registered activity sessions was 4.79 (95% CI; 4.07–5.50) per patient per week.
Table 1. Baseline and primary outcome parameters Baseline Control Programme (n=90) mCR Programme (n=89) P-value Gender (m/f) 76/14 69/20 0.238 Age (mean±SD) 73.57±5.46 72.38±5.37 0.121 Diabetes 15 (16.7%) 23 (25.8%) 0.133 Hypertension 60 (66.7%) 73 (82.0%) 0.019* Hypercholesteremia 71 (78.3%) 74 (83.1%) 0.468 Normal LV-function 48/89 (53.9%) 53/89 (59.6%) 0.497 Index event (CABG/Valve/PCI/none) 0.735 Cardiac history prior to index event 48/89 (53.9%) 53/89 (59.6%) 0.702 Non cardiac comorbidity 40 (44.4%) 44 (49.4%) 0.503 Results Baseline VO2peak (ml/kg/min) (95% CI) 19.83 (18.65–21.01) 18.78 (18.67–19.89) 0.191 Delta VO2peak at 6 months (ml/kg/min) (95% CI) 0.20 4 (−0.34–0.83) 1.62 (0.86–2.39) 0.005* Corrected delta VO2peak at 6 months (ml/kg/min) 0.50 (−1.04–2.04) 1.65 (0.11–3.2) 0.015* *Significant.
Conclusions
The application of mCR in elderly patients who declined regular CR results in a better physical condition after 6 months. Compliance to mCR was excellent.
Acknowledgement/Funding
European Union's Horizon 2020 research and innovation programme under grant agreement number 634439, and funding from the Swiss Government.
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Affiliation(s)
| | | | - E P Meindersma
- Radboud University Medical Centre, Nijmegen, Netherlands (The)
| | - L F Prins
- Diagram BV, Zwolle, Netherlands (The)
| | - M Wilhelm
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - M C Iliou
- Assistance Hopiteaux Publique de Paris, Paris, France
| | - C Pena Gil
- University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - J A Snoek
- Isala Hospital, Zwolle, Netherlands (The)
| | - E Kolkman
- Diagram BV, Zwolle, Netherlands (The)
| | - A W J Van't Hof
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - E Prescott
- Bispebjerg University Hospital, Copenhagen, Denmark
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