{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:53:54Z","timestamp":1782867234762,"version":"3.54.5"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>A sex-based evaluation of prognosis in heart failure (HF) is lacking.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>We analyzed the Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score registry, which includes HF with reduced ejection fraction (HFrEF) patients. A cross-validation procedure was performed to estimate weights separately for men and women of all MECKI score parameters: left ventricular ejection fraction (LVEF), hemoglobin, kidney function assessed by Modification of Diet in Renal Disease, blood sodium level, ventilation vs. carbon dioxide production slope, and peak oxygen consumption (peakVO<jats:sub>2<\/jats:sub>). The primary outcomes were the composite of all-cause mortality, urgent heart transplant, and implant of a left ventricle assist device. The difference in predictive ability between the native and sex recalibrated MECKI (S-MECKI) was calculated using a receiver operating characteristic (ROC) curve at 2 years and a calibration plot. We retrospectively analyzed 7,900 HFrEF patients included in the MECKI score registry (mean age 61\u2009\u00b1\u200913\u2005years, 6,456 men\/1,444 women, mean LVEF 33%\u2009\u00b1\u200910%, mean peakVO<jats:sub>2<\/jats:sub> 56.2%\u2009\u00b1\u200917.6% of predicted) with a median follow-up of 4.05\u2005years (range 1.72\u20137.47). Our results revealed an unadjusted risk of events that was doubled in men compared to women (9.7 vs. 4.1) and a significant difference in weight between the sexes of most of the parameters included in the MECKI score. S-MECKI showed improved risk classification and accuracy (area under the ROC curve: 0.7893 vs. 0.7799, <jats:italic>p<\/jats:italic>\u2009=\u20090.02) due to prognostication improvement in the high-risk settings in both sexes (MECKI score &amp;gt;10 in men and &amp;gt;5 in women).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>S-MECKI, i.e., the recalibrated MECKI according to sex-specific differences, constitutes a further step in the prognostic assessment of patients with severe HFrEF.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1390544","type":"journal-article","created":{"date-parts":[[2024,7,5]],"date-time":"2024-07-05T18:21:31Z","timestamp":1720203691000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["A matter of sex\u2014persistent predictive value of MECKI score prognostic power in men and women with heart failure and reduced ejection fraction: a multicenter 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