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Validation of the MEDIA echo score for the prognosis of heart failure with preserved ejection fraction

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Abstract

There is currently no widely used prognostic score in heart failure (HF) with preserved ejection fraction (HFpEF). The MEDIA echo score, including four variables (pulmonary arterial systolic pressure > 40 mmHg, inferior vena cava collapsibility index < 50%, average E/e′ > 9, and lateral mitral annular s′ < 7 cm/s), has been proposed as a useful risk stratification tool. This study aimed at further validating the MEDIA echo score in both hospitalised and ambulatory HFpEF patients. The MEDIA echo score ranges from 0 to 4 (each criterion scores 1 point). The associations between MEDIA echo score and cardiovascular outcomes were assessed in two independent HFpEF cohorts, namely patients hospitalised for worsening HFpEF (N = 242, mean age 78 ± 11), and stable ambulatory HFpEF patients (N = 76, mean age 65 ± 8). Using multivariable Cox models, in the worsening HFpEF cohort, patients with a MEDIA echo score of 3–4 displayed a significant increased risk of death (HR 2.10, 95%CI 1.02–4.33, P = 0.043, score 0–1 as reference). In the ambulatory HFpEF cohort, patients with a MEDIA echo score of 2 had a significantly higher risk of death or HF hospitalisation (HR 3.44, 95%CI 1.27–9.30, P = 0.015, score 0 as reference), driven by HF hospitalisation; in that cohort, adding the MEDIA echo score to the clinical model significantly improved reclassification for the combined endpoint (integrated discrimination improvement 6.2%, P = 0.006). The MEDIA echo score significantly predicted the outcome of HFpEF patients in both hospital and ambulatory settings; its use may help refine routine risk stratification on top of well-established prognosticators in stable HFpEF patients.

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Abbreviations

ANOVA:

Analysis of variance test

BMI:

Body mass index

CI:

Confidence interval

DT:

Deceleration time

eGFR:

Estimated glomerular filtration rate

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

HR:

Hazard ratio

IVC:

Inferior vena cava

IDI:

Integrated discriminative improvement  

IQR:

Interquartile range

LAVi:

Left atrial volume index

LV:

Left ventricular

LVEF:

Left ventricular ejection fraction

NRI:

Net reclassification improvement

PASP:

Pulmonary arterial systolic pressure

SV:

Stroke volume

TAPSE:

Tricuspid annular peak systolic excursion

TRV:

Tricuspid regurgitation velocity

TDI:

Tissue Doppler imaging

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Authors and Affiliations

  1. Cardiology Department, Santa Maria Della Misericordia Hospital, Perugia, Italy

    Stefano Coiro

  2. Centre D’Investigation Clinique-Plurithématique Inserm CIC-P 1433, Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Université de Lorraine, Nancy, France

    Stefano Coiro, Olivier Huttin, Masatake Kobayashi, Zohra Lamiral, Faiez Zannad, Patrick Rossignol & Nicolas Girerd

  3. Institute for Treatment and Rehabilitation “Niska Banja”, Clinic of Cardiology, University of Nis School of Medicine, Nis, Serbia

    Dejan Simonovic

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  1. Stefano Coiro
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Correspondence to Nicolas Girerd.

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Ethical standards

Under French law, the analysis of mono-centre hospital data does not require written informed consent or ethical committee approval. The study on the ambulatory HFpEF cohort of the Cardiology Clinic of the Niska Banja was approved by the local ethics committee and managed in accordance with Good Clinical Practice and the Declaration of Helsinki. All patients provided written informed consent.

Conflict of interest

Pr Girerd. reports personal fees from AstraZeneca, Bayer, Boehringer, Lilly, Novartis, and Vifor, outside the submitted work. Pr Rossignol reports (outside this manuscript) consulting for Bayer, CinCor, G3P, Idorsia, and KBP; honoraria from Ablative Solutions, AstraZeneca, Bayer, Boehringer-Ingelheim, Corvidia, CVRx, Fresenius, Grunenthal, Novartis, Novo Nordisk, Roche, Relypsa Inc., a Vifor Pharma Group Company, Sanofi, Sequana Medical, Servier, Stealth Peptides, and Vifor Fresenius Medical Care Renal Pharma; Cofounder: CardioRenal. All of the other authors have nothing to declare.

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Coiro, S., Huttin, O., Kobayashi, M. et al. Validation of the MEDIA echo score for the prognosis of heart failure with preserved ejection fraction. Heart Fail Rev 28, 453–464 (2023). https://doi.org/10.1007/s10741-022-10266-2

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