Validation of the MEDIA echo score for the prognosis of heart failure with preserved ejection fraction
Abstract
Background: There is currently no widely used prognostic score in heart failure with preserved ejection fraction (HFpEF). The MEDIA echo score, including four variables [pulmonary arterial systolic pressure >40mmHg, inferior vena cava collapsibility index <50%, average E/e' >9, and lateral mitral annular s' <7cm/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. Methods: the MEDIA echo score ranges from 0 to 4 (each criterion score 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=72, mean age 65±8). Results: Using multivariable Cox models, in the worsening HFpEF cohort, patients with a MEDIA echo score 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 ≥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). Conclusions: 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 wellestablished prognosticators in stable HFpEF patients.
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