Response by Pibarot et al to Letter Regarding Article, “Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients: The PARTNER 3 Trial”
Notice bibliographique
Résumé
In Response:We thank Loardi and Zanobini, Pollari et al, and Useini and Strauch for their interest in and comments regarding our article reporting echocardiographic data of the PARTNER 3 trial (Placement of Aortic Transcatheter Valves). 1 There is a growing body of evidence suggesting that, as opposed to transcatheter aortic valve replacement (TAVR), surgical aortic valve replacement (SAVR) is associated with a deterioration in right ventricular (RV) function, which may contribute to the worse clinical outcomes observed with SAVR versus TAVR in the population with low surgical risk of the PARTNER 3 trial.Consistent with these results, an analysis of the PARTNER 2A trial also revealed that worsening of RV function occurs 3-fold more frequently after SAVR versus TAVR in the intermediate-risk population and is associated with a 2.87-fold increase in mortality.2 As discussed in our article, the causes of the deterioration of RV function and of tricuspid regurgitation after SAVR are likely multifactorial, including potential detrimental effects of pericardiectomy and of cardiopulmonary bypass.We disagree with the concept suggested in some previous studies that the deterioration in RV longitudinal systolic function and thus of tricuspid annulus plane excursion observed after SAVR does not indicate a true deterioration in RV function and has no functional or clinical consequences.The marked deterioration of tricuspid annulus plane excursion that occurred from baseline to 30 days in the SAVR arm of the PARTNER 3 trial was paralleled by a worsening of tricuspid regurgitation and was strongly and independently associated with worse clinical outcomes, substantiating the clinical relevance of this finding.Valvulo-arterial impedance (Zva) is not solely a measure of bioprosthetic valve function but also integrates left ventricular (LV) outflow and arterial hemodynamics.Hence, Zva has the advantage of providing a more comprehensive assessment of the effect of aortic valve replacement (AVR) on the overall performance of the ventriculo-valvulo-arterial system.This measure reflects the overall energy cost (expressed in mm Hg) per milliliter of blood (indexed to body size) ejected by the heart.The results of the PARTNER 3 trial suggest that TAVR is associated with greater reduction in Zva and thus in LV energy cost compared with SAVR.However, Zva has limitations, including the fact that it is, as are all other echocardiographic measures of valve function, flow-dependent, and it is subject to measurement variability given that its formula includes 3 echocardiographic measures.The fact that the change in stroke volume does not parallel the change in LV ejection fraction after AVR is not surprising.Besides LV systolic function, several other factors may contribute to the increase in LV stroke volume after AVR, including the regression of LV concentric hypertrophy or remodeling, improvement in LV diastolic function and filling, and regression of mitral regurgitation and tricuspid regurgitation. 3 These factors may have contributed to the higher increase in stroke volume observed
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,033 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,004 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,042 | 0,027 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,009 | 0,008 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».