Abnormal Left Ventricular Geometry in Lacunar Stroke: Spectrum, Prevalence and Prognostic Implications in the SPS3 Trial (S15.001)
Bibliographic record
Abstract
OBJECTIVE Define the spectrum of left ventricular geometry (LVG) and its association with baseline clinical and neuroradiological features and outcomes in patients with lacunar infarcts. BACKGROUND The role of structural heart disease in lacunar stroke patients is not well defined. Echocardiography is frequently used to ascertain stroke mechanism. Though this modality rarely identifies a cardioembolic mechanism in lacunar patients, the spectrum, prevalence and prognostic implications of abnormal LVG in these patients is unknown. DESIGN/METHODS Data is from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial. Patients with recent symptomatic lacunar infarcts were randomized to higher (130-149 mmHg) vs. lower (<130 mmHg) blood pressure targets and single vs. dual antiplatelet (AP) therapy. LVG on transthoracic echocardiography (TTE) was classified as normal (N), concentric remodeling (CR), concentric hypertrophy (CH), or eccentric hypertrophy (EH) using the Devereaux formula. Bi- and multinomial multivariable (MV) logistic regression models identified independent characteristics. RESULTS 1961 subjects (mean (sd) age 63(11); 64% male) were followed a mean of 3.5(1.9) years. N LVG was present in 23%, CH 31%, CR 39%, EH 7%. Abnormal LVG was independently associated with sex, diabetes, history and severity of hypertension, race-ethnicity and decreased renal function. Subjects with CH vs. N LVG were more likely to have advanced neurological manifestations of small vessel disease (SVD) including previous subcortical infarcts (MV OR1.9, 95% CI 1.5-2.5) and white matter hypertensities (MV OR mod 1.8, CI 1.3-2.5; severe 1.9, 1.3-2.7 vs. none-mild). LVG remained predictive of stroke recurrence after adjusting for assigned treatments and risk factors (HR for CR vs. N LVG 1.7, 95% CI 1.1-2.7). There was no interaction between LVG and AP (p=0.5) or BP target (0.9). CONCLUSIONS LVG consistent with chronic hypertensive changes is present in a large subset of lacunar stroke patients, is associated with distinct risk factors, and correlates with neuroradiological manifestations of SVD. TTE in lacunar patients yields valuable information with regards to severity of small vessel disease and prognosis.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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".