In Reference to “Tricuspid Regurgitation on Echocardiography May Not Be a Predictor of Patient Survival After Liver Transplantation”
Bibliographic record
Abstract
To the Editor: We appreciate the commentary by Leithead et al (1Leithead JA Kandiah K Steed H Gunson BK Steeds RP Ferguson JW Tricuspid regurgitation on echocardiography may not be a predictor of patient survival after liver transplantation.Am J Transplant. 2014; 14: 2193-2194Abstract Full Text Full Text PDF Scopus (8) Google Scholar) in response to our study evaluating the role of pretransplant echocardiography in predicting outcomes following liver transplantation (LT). In our retrospective study of 216 patients who underwent pre-LT echocardiography, we found the presence of ≥ mild tricuspid regurgitation (TR) to be predictive of patient and graft survival (2Kia L Shah SJ Wang E et al.Role of pretransplant echocardiographic evaluation in predicting outcomes following liver transplantation.Am J Transplant. 2013; 13: 2395-2401Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar). Leithead et al (1Leithead JA Kandiah K Steed H Gunson BK Steeds RP Ferguson JW Tricuspid regurgitation on echocardiography may not be a predictor of patient survival after liver transplantation.Am J Transplant. 2014; 14: 2193-2194Abstract Full Text Full Text PDF Scopus (8) Google Scholar) performed a somewhat similar study at their institution, and their data do not demonstrate an association, and they suggest that our findings should be interpreted with caution. We acknowledge that their findings are in fact very interesting, although it is difficult to directly compare our studies and patient populations. First, the authors do not specify in their methods how the echocardiographic data were extracted. There can be significant interobserver variability in grading TR, which was not a consideration in our study as all echocardiograms were read by a single, trained, blinded reader using predefined, established criteria (3Rudski LG Lai WW Afilalo J et al.Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography.J Am Soc Echocardiogr. 2010; 23: 685-713Abstract Full Text Full Text PDF PubMed Scopus (4863) Google Scholar,4Zoghbi WA Enriquez-Sarano M Foster E et al.Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography.J Am Soc Echocardiogr. 2003; 16: 777-802Abstract Full Text Full Text PDF PubMed Scopus (3389) Google Scholar). It is unclear whether a similar protocol was used in their data set. Second, the authors state that they excluded patients with pulmonary hypertension, but they do not define the parameters by which they were excluded from analysis. Our study excluded only patients with moderate-to-severe portopulmonary hypertension who were deemed not to be transplant candidates. Last, as the authors point out, their patient population had an average calculated Model for End-Stage Liver Disease (MELD) score that was much lower than ours (15 vs. 25), suggesting that our population was sicker with less reserve and more susceptible to subtle hemodynamic changes such as mild TR. In summary, we agree that TR in healthier populations (lower MELD, no pulmonary hypertension) may have less impact on patient and graft survival, but as liver failure advances and transplantation becomes more imminent in our region and others in the United States, our data suggest a greater impact of TR. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.
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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 | 0.009 | 0.069 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.004 |
| Scholarly communication | 0.004 | 0.004 |
| Open science | 0.007 | 0.002 |
| Research integrity | 0.021 | 0.031 |
| Insufficient payload (model declined to judge) | 0.004 | 0.004 |
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".