Abstract T MP113: Symptoms During Carotid Sinus Massage, but Not the Magnitude of Haemodynamic Change, are Associated with White Matter Lesions in Later Life
Bibliographic record
Abstract
Introduction: White matter hyperintensities (WMH) on MRI are common in older people and are associated with cognitive impairment, falls and depression. They are believed to represent cerebrovascular small vessel disease but as frank infarction is not always seen it is suggested that WMH represent damage resulting from hypoperfusion. Carotid sinus hypersensitivity (CSH) is an exaggerated fall in blood pressure (BP) or heart rate (HR) in response to stimulation of the carotid sinus. It is defined as a ≥50 mmHg drop in systolic BP & / or ≥3 second asystole in response to carotid sinus massage (CSM). CSH, is often associated with syncope & presyncope, thought to indicate cerebral hypoperfusion. Aim: To examine, over a ten year follow-up, if CSH is associated with WMH volume. Method: In 2002, 274 people age ≥65 underwent CSM. BP & HR response were recorded using beat to beat monitoring. Symptoms suggestive of cerebral hypoperfusion e.g. syncope or presyncope were recorded. In 2012, 53 of these participants underwent MRI. Volume of WMH was calculated using a validated quantitative method. Results: Of the 53 participants who underwent MRI, 17 had CSH. Presence of CSH was not associated with WMH volume. Mean BP response was 46.5 mmHg (SD 20.4) and mean HR response was 2.5s (SD 1.9). Change in BP or HR were not associated with WMH volume. Eight of the 53 participants had syncope or presyncope during CSM. These symptoms were significantly associated with greater total WMH volume (P=0.004) & greater periventricular WMH volumes (P=0.001). Findings remained significant after adjusting for age, sex & history of hypertension, [total WMH R 2 0.29 (p=0.006) & periventricular WMH R 2 0.34 (P=0.002)]. Conclusion: Presyncope or syncope during CSM, rather than hemodynamic response, predict volume of WMH. These findings suggest clinical symptoms of cerebral hypoperfusion rather than hemodynamic changes are a better indicator of patients at risk of WMH.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.009 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".