Do postoperative hemodynamic parameters add prognostic value for the prediction of mortality after surgical aortic valve replacement?
Notice bibliographique
Résumé
Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The PERIGON Pivotal Trial was funded by Medtronic. Background While different parameters to assess prosthetic valve performance are available, prosthesis-patient mismatch (PPM) is exclusively based on indexed effective orifice area (EOAi). Purpose We investigated the prognostic value of multiple postoperative hemodynamic parameters, independent of the STS predicted risk of mortality (STS PROM), for prediction of 5-year mortality after surgical aortic valve replacement (SAVR). Methods The study population consisted of patients enrolled in a prospective multicenter study. All patients underwent SAVR with the same stented bioprosthesis. Patients who underwent previous open-heart surgery, or died or withdrew consent before echocardiographic assessment at their first follow-up visit (3–6 months), were excluded. Cox regression models were fitted to estimate the relation between STS PROM, postoperative hemodynamic parameters (as continuous variables except for PPM), and all-cause mortality. Follow-up started at the first postoperative outpatient clinic visit and continued until death or withdrawal from the study, whichever came first. In addition to the STS PROM, candidate predictors included peak aortic jet velocity (Vmax), mean pressure gradient (MPG), EOA, predicted and measured EOAi, Doppler velocity index (DVI), internal prosthesis orifice area indexed (POAi) by stroke volume, and Valve Academic Research Consortium (VARC) 3 categories for PPM (1). All echocardiograms were evaluated by a core laboratory. Although the STS PROM was initially developed to predict 30-day mortality (2), it has also been proven to predict late mortality (3). Model performance was investigated using the c-statistic, likelihood ratio test, and net reclassification improvement (NRI), among others. Results Among 1118 patients enrolled, 1022 patients were included in the study. Patients were on average 70 years, 75% was male, and 88% had a left ventricle ejection fraction of ≥50%. At 5-year follow-up, 89 patients had died, and the median follow-up time was 1697 days. In univariate analysis, STS PROM was the only significant predictor of 5-year mortality (hazard ratio 1.40, 95%-confidence interval [CI] 1.26, 1.55). Moreover, STS PROM performed best in terms of the c-statistic (0.66, 95%-CI 0.60, 0.72). When extending the STS PROM with single hemodynamic parameters (Table 1), neither the c-statistics nor the NRI demonstrated added prognostic value compared to a model with STS PROM alone. Similar findings were observed when multiple hemodynamic parameters were added to STS PROM (c-statistic 0.68, 95%-CI 0.62, 0.74, and NRI 0.04, 95%-CI −0.08, 0.16). Conclusions The STS PROM was found to be the main predictor of patients’ prognosis. In this analysis, the added prognostic value of postoperative hemodynamic parameters for 5-year mortality after SAVR was limited (Figure 1). These results warrant further research on the value of PPM, residual postoperative hemodynamic obstruction and their relation with adverse outcomes.
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 distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,006 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
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 tête enseignante, 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 ».