Abstract 12969: Rapid Nonsustained Ventricular Tachycardia Detected by Continuous Device Monitoring for Risk Stratification in Hypertrophic Cardiomyopathy: Redefining a Traditional Risk Marker
Bibliographic record
Abstract
Introduction: Nonsustained VT (NSVT) detected by Holter (Holter +NSVT) is a major risk factor (RF) for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). We hypothesized that using a higher heart rate cut-off and prolonged monitoring for detecting NSVT would improve its accuracy in predicting sustained ventricular arrhythmias (VA). Methods: We prospectively enrolled 56 patients (mean 44±14 yrs) with HCM, who had a preexisting prophylactic ICD. We assessed the prevalence of rapid NSVT (+RNSVT, ≥4 beats at 167-200 bpm) detected by their ICD within the first 12 months of implant. The primary outcome was appropriate ICD therapy after implant. Results: The prevalence of RF at ICD implant was 50% for syncope, 57% for Holter +NSVT, 45% for +family history SCD, and 25% for septum ≥ 30mm. The prevalence of 0, 1, 2 and ≥3 RF was 2, 32, 54 and 13%, respectively. +RNSVT occurred in 19 patients (34%) of whom 4 were Holter -NSVT. When compared to -RNSVT, those with +RNSVT had less syncope (21 vs 65%, p=0.004) but more Holter +NSVT (79 vs 46%, p=0.02). Over a median follow-up of 59 (25, 123) months after ICD implant, 8 patients had ≥1 appropriate ICD therapy from VA. According to the number of RF, the proportion of patients with VA was 0=0%, 1=6%, 2=13%, ≥3=43% (p=0.11). +RNSVT was associated with higher VA compared to Holter +NSVT (Figure 1A). +RNSVT predicted VA by Cox regression analysis, both univariate [odds ratio 10, 95% CI 1-84, p=0.03] and adjusted for differences in RF [adjusted odds ratio 11, 95% CI 1-114, p=0.046]. ROC analysis for +RNSVT (area under curve 0.78, p=0.02) showed the optimal cut-point to be RNSVT ≥2 episodes (Figure 1B) for discriminating patients with and without VA (Sensitivity 71%, Specificity 83%, PPV 38%, NPV 95%). Conclusions: RNSVT detected from continuous device monitoring is an independent predictor of VA in HCM patients and a better risk stratifier than Holter +NSVT. The role of implantable loop monitoring to detect RNSVT and evaluate VA risk in HCM warrants study
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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 | 0.001 | 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) | 0.002 | 0.000 |
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".