MECKI Score (Cardiopulmonary Exercise + Clinical) Calculator

MECKI Score (Metabolic Exercise test data combined with Cardiac and Kidney Indexes): Explanation and clinical context The MECKI score is a prognostic model developed in a large multicenter registry of patients with heart failure and reduced ejection fraction. It integrates two cardiopulmonary exercise test (CPET) variables—percent predicted peak oxygen uptake (%predicted peak VO2) and VE/VCO2 slope—with routine clinical and laboratory parameters: left ventricular ejection fraction (LVEF), hemoglobin concentration, serum sodium, and renal function (eGFR). The original model uses a logistic regression linear predictor (see formula above) to generate a probability of the combined endpoint (cardiovascular mortality and urgent heart transplantation / LVAD) over follow-up; the model has been externally validated in subsequent studies and compared favorably to other HF risk scores when CPET data are available.

How to use this tool in practice: Use accurate, contemporaneous CPET-derived %predicted peak VO2 and VE/VCO2 slope, an LVEF measured by standard echocardiographic methods, laboratory values obtained close to the time of CPET (hemoglobin and sodium), and an eGFR calculated using your preferred equation (the original derivation used MDRD). Enter numeric values into the fields above to obtain the MECKI probability. Interpret results in the clinical context—MECKI provides an incremental prognostic estimate particularly valuable when CPET is performed; it is not a substitute for comprehensive clinical judgment.

Interpretation guidance (commonly used categories): MECKI probability <10% is generally considered low risk, 10–20% intermediate risk, and >20% high risk for the composite cardiovascular event used in MECKI publications. Use these categories as one component of shared clinical decision-making (e.g., advanced therapies discussion, transplant/VAD evaluation referral), alongside guideline recommendations and individual patient factors. Limitations: The score was derived in patients able to perform CPET and with HFrEF; application to HFpEF or patients unable to exercise may be inappropriate.

Differences in eGFR formula, method of VO2 predicted calculation, or local population characteristics can alter calibration—consider local validation when possible. Risk estimates are probabilistic and should be combined with longitudinal clinical assessment.