The Relationship between the MAGGIC Score and Cardiorenal Syndrome in Patients with Acute Decompensated Heart Failure with Reduced Ejection Fraction.

Background: The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient clinics or at the bedside, and was developed to predict the survival of heart failure patients after hospitalization. Objectives: This study aims to evaluate the relationship between the MAGGIC score and cardiorenal syndrome (CRS) in patients with acute decompensated heart failure with reduced ejection fraction (HFrEF). Methods: This retrospective, single-center study, included 706 patients with New York Heart Association II-IV who were hospitalized and discharged for acute decompensated heart failure between 2016 and 2021. CRS type 1 was defined as acute worsening of cardiac function leading to renal dysfunction. Patients were divided into two groups: those with CRS and those without. The MAGGIC score of all patients was determined. The primary outcome was the occurrence of CRS. Results: CRS developed in 132 patients. The MAGGIC score was higher in CRS (+) patients compared to CRS (-) patients (30.70 ± 8.09 vs. 23.96 ± 5.59, p < 0.001). After a multivariable analysis, MAGGIC score [odds ratio (OR): 3.92, p < 0.001], sodium (OR: 0.92, p = 0.003), N terminal pro B type natriuretic peptide (OR: 1.78, p = 0.009), hs troponin (OR: 1.28, p = 0.044), MRA (OR: 0.61, p = 0.019) and furosemide dose (OR: 1.03, p = 0.001) were found to be independent predictors of CRS development. The MAGGIC score was associated with CRS development (area under curve = 0.778). Conclusions: The MAGGIC score may be associated with CRS in HFrEF patients.

Prognostic significance of addition of electrocardiographic findings to the MAGGIC heart failure risk score.

BACKGROUND: The Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) is a scoring system that is easy to use in outpatient or inpatient settings and was developed to predict the survival of heart failure (HF) patients after hospitalization. AIM: This study aims to determine the prognostic significance of MAGGIC risk score combined with electrocardiography (ECG) parameters in decompensated patients with heart failure with reduced left ventricular ejection fraction (HFrEF) who were hospitalized for worsening HF. METHODS: A total of 562 HF patients with New York Heart Association (NYHA) II-IV functional class who were discharged after hospitalization for decompensated HF between 2013 and 2018 in a single center were included. MAGGIC risk scores of all participating patients were calculated according to baseline characteristics gathered using data from the initial hospitalization for HF. In addition, electrocardiographic findings of all patients were examined. RESULTS: During the follow-up period (4.5 ± 1.2 years) 177 patients died. MAGGIC scores were observed to be higher in non-survivors compared to surviving patients (28.69 ± 7.01 vs. 22.82 ± 6.05, p < 0.001). After a multivariate analysis, MAGGIC score (OR:1.090, p < 0.001), development of cardio-renal syndrome (OR:2.035, p < 0.001), presence of left bundle branch block (LBBB) (OR:1.931, p < 0.001), atrial fibrillation (AF) (OR:1.817, p < 0.001), and fragmented QRS (fQRS) (OR:1.671, p = 0.002) on ECG were found to be independent predictors of mortality. While the MAGGIC score was shown to predict mortality (AUC = 0.739), its predictive power was improved when combined with AF (AUC = 0.752), LBBB (AUC = 0.745), and fQRS (AUC = 0.757) respectively, as well as in the combined final model (MAGGIC score, AF, LBBB, fQRS) (AUC = 0.787). CONCLUSIONS: Our findings showed that addition of electrocardiographic findings to the MAGGIC heart failure risk score has prognostic significance in decompensated patients with HFrEF.

The MAGGIC risk score predicts mortality in patients undergoing transcatheter aortic valve replacement: sub-analysis of the OCEAN-TAVI registry.

This study is aimed to evaluate the performance of MAGGIC risk score for predicting mortality by external validation using multicenter transcatheter aortic valve replacement (TAVR) registry. We assessed 1383 patients who underwent TAVR from October 2013 to April 2016. Patients were divided into 2 groups according to the median of MAGGIC score and we compared the incidence of all-cause death between high and low MAGGIC score. To assess whether the MAGGIC risk score add prognostic value on STS risk score, we also compared the incidence of all-cause death between the 2 groups according to low, intermediate, and high STS score. The median of MAGGIC score was 29 (interquartile range: 13-46). Within 2 years, 147 cases of all-cause death were observed. The high MAGGIC (30-46) risk score was significantly associated with an increased risk of all-cause death as compared to low MAGGIC (11-29) risk score and this relationship was also observed in patients with high STS risk score. However, this relationship was not observed in patients with low and intermediate STS score. Multivariate analysis showed that the MAGGIC risk score was an independent predictor of all-cause death (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11). Our results demonstrated that the MAGGIC score predicts all-cause death in TAVR population and provides better risk stratification, particularly in patients with high STS risk.

Activation of the ergoreceptors in cardiac patients with and without heart failure.

BACKGROUND: The presence of ergoreflex activity and its current relationship to hyperventilation and prognosis in cardiac patients is unclear. Therefore, we evaluated ergoreflex activity in cardiac patients with and without heart failure (CHF) as well as in healthy subjects, and we examined how ergoreceptor activity was related to a mortality risk score in CHF (MAGGIC). METHODS AND RESULTS: Twenty-five healthy subjects and 76 patients were included, among whom were 25 with ischemic heart disease (IHD), 24 with stable CHF, and 27 with unstable CHF. Ergoreflex activity was measured with a dynamic handgrip exercise, followed by post-handgrip regional circulatory occlusion (PH-RCO). Ergoreflex activity contributed significantly to ventilation (median [interquartile range] %V) in unstable CHF (81 [73-91] %V without PH-RCO, 92 [82-107] %V with PH-RCO, and 11 [6-20] difference in %V; P < .001) and was positively correlated with the MAGGIC risk score (Spearman ρ = 0.431; P = .002). No ergoreflex activity was observed in healthy subjects (-4 [-10 to 5] difference in %V), IHD (0 [-8 to 3] Diff in %V) and stable CHF (-3 [-11 to 6] difference in %V). CONCLUSIONS: Ergoreflex activity contributes to hyperventilation, but only in CHF patients with persistent symptoms, and is closely related to the MAGGIC risk score. Ergoreflex activity was not present in patients with IHD or stable CHF, suggesting other reasons for the increased ventilatory drive in those patients.