What is the clinical evidence from this study?

Study design: Observational. Population: Adults undergoing cardiopulmonary exercise testing with and without heart failure with reduced ejection fraction including a mixed racially diverse US cohort (n=803). Intervention: MECKI score vs. CPX Risk score. Primary outcome: Composite of death, heart failure hospitalization, heart transplantation, or left ventricular assist device implantation within 2 years (AUC 0.861 for MECKI score vs AUC 0.728 for CPX Risk score, 95% CI MECKI score 0.820–0.903; CPX Risk score 0.669–0.788, p=<0.001).

What question did this study set out to answer?

To assess the prognostic performance of the MECKI score in predicting outcomes in heart failure patients in an American cohort.

February 14, 2026Physiological ReportsOpen Access

Prognostic utility of the MECKI score in a mixed United States cohort

Q: What are the key findings of this study?

The MECKI score outperformed the CPX Risk score in predicting 2-year adverse events, with an AUC of 0.861 versus 0.728 in a mixed US cohort undergoing cardiopulmonary exercise testing.

Q: What does this research mean for the field?

The MECKI score outperforms the CPX Risk score in predicting 2-year adverse events in a mixed US cohort undergoing cardiopulmonary exercise testing. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the prognostic performance of the MECKI score in predicting outcomes in heart failure patients in an American cohort.

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Key result

MECKI score outperforms CPX Risk score in predicting 2-year major events.

AUC 0.861 for MECKI score vs AUC 0.728 for CPX Risk score
95% CI MECKI score 0.820–0.903; CPX Risk score 0.669–0.788
P<0.001
n=803

Why the study?

The MECKI score has demonstrated prognostic utility in European and Asian HFrEF cohorts, but its performance in an American cohort had not been evaluated.

Does the MECKI score accurately predict the composite of death, heart failure hospitalization, heart transplantation, or LVAD implantation compared to the CPX Risk score in a mixed US cohort?

Population

803 patients undergoing CPX at a single institution

Comparison

MECKI score vs CPX Risk score

Design

Retrospective cohort study

Authors

AMAdarsh MallepallyVirginia Commonwealth University KDKaivalya DandamudiVirginia Commonwealth University MKMatthew G. KayeVirginia Commonwealth University

Discussion

Member takes

Implication

May inform US HF risk stratification; extends European/Asian data but leaves adoption open pending prospective trials.

Key Points

To assess the prognostic performance of the MECKI score in predicting outcomes in heart failure patients in an American cohort.
Retrospective identification of patients undergoing cardiopulmonary exercise testing from 2022 to 2024.
Calculation of MECKI and CPX Risk scores based on exercise test data.
Primary endpoint focused on composite outcomes including death, heart failure admissions, heart transplantation, or ventricular assist device.
Survival analysis performed using Kaplan–Meier curves and log-rank tests with ROC curve comparisons.
803 patients included, with demographic representation of 56% female and 28% Black.
90% of patients had MECKI scores <10%, showing stepwise increases in risk of primary endpoints (log-rank χ2 = 196.0, p < 0.001).
MECKI scores outperformed CPX Risk scores in predictive ability for outcomes.
The MECKI score also effectively predicted events in patients with HFrEF.

Study Design

Type

Observational (n=803)

Multicenter

Structured PICO

Does the MECKI score accurately predict the composite of death, heart failure hospitalization, heart transplantation, or LVAD implantation compared to the CPX Risk score in a mixed US cohort?

Population

803 adult patients who underwent first cardiopulmonary exercise testing (CPX) at a single US institution (2022-2024), median age 52, 56% female, 28% Black. 41% had pre-existing heart failure (23% HFrEF with LVEF ≤45%).

Intervention

Risk stratification using the MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes) score

Comparator

Risk stratification using the CPX Risk score

Outcome

Composite of death, heart failure hospitalization (defined as admission for decompensated heart failure requiring intravenous diuretics), heart transplantation, or left ventricular assist device implantationcomposite

Main Result

Effect estimate: AUC 0.861 for MECKI score vs AUC 0.728 for CPX Risk score (95% CI MECKI score 0.820–0.903; CPX Risk score 0.669–0.788)

p-value: p=<0.001

The MECKI score provides robust prognostic utility for predicting adverse heart failure events in a diverse US cohort, outperforming standard CPX-based risk assessments.

Limitations

Single center retrospective analysis limiting generalizability
Relatively small sample size limiting subgroup analysis
VE/VCO2 slope calculated to peak exercise instead of respiratory compensation point which may affect prognostic performance
Use of older equation (MDRD) for estimated glomerular filtration rate which may affect MECKI score accuracy
Single center retrospective analysis
Relatively small cohort limiting further subgroup analyses
VE:VCO2 slope measured to peak exercise rather than respiratory compensation point

Cite This Study

Mallepally et al. (2026) conducted an observational in Adults undergoing cardiopulmonary exercise testing with and without heart failure with reduced ejection fraction including a mixed racially diverse US cohort (n=803). MECKI score vs. CPX Risk score was evaluated on Composite of death, heart failure hospitalization, heart transplantation, or left ventricular assist device implantation within 2 years (AUC 0.861 for MECKI score vs AUC 0.728 for CPX Risk score, 95% CI MECKI score 0.820–0.903; CPX Risk score 0.669–0.788, p=<0.001). The MECKI score outperformed the CPX Risk score in predicting 2-year adverse events, with an AUC of 0.861 versus 0.728 in a mixed US cohort undergoing cardiopulmonary exercise testing.

synapsesocial.com/papers/6990113f2ccff479cfe57b9a https://doi.org/10.14814/phy2.70770

Topics

HFrEF treatment Heart failure

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Prognostic utility of the MECKI score in a mixed United States cohort

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Prognostic utility of the MECKI score in a mixed United States cohort

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider