Cardiopulmonary Exercise Testing to Detect Chronic Thromboembolic Pulmonary Hypertension in Patients with Normal Echocardiography
Why this work is in the frame
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Bibliographic record
Abstract
<b><i>Background:</i></b> Chronic thromboembolic pulmonary hypertension (CTEPH) is a serious complication of pulmonary embolism (PE). Taking into account the reported incidence of CTEPH after acute PE, the number of patients with undiagnosed CTEPH may be high. <b><i>Objectives:</i></b> We aimed to determine if cardiopulmonary exercise testing (CPET) could serve as complementary tool in the diagnosis of CTEPH and can detect CTEPH in patients with normal echocardiography. <b><i>Methods:</i></b> At diagnosis, we analyzed the data of CPET parameters in 42 patients with proven CTEPH and 51 controls, and evaluated the performance of two scores. <b><i>Results:</i></b> V<smlcap>E</smlcap>/V<smlcap>CO</smlcap><sub>2</sub> slope, EQ<smlcap>O</smlcap><sub>2</sub>, EQ<smlcap>CO</smlcap><sub>2</sub>, P(A-a)<smlcap>O</smlcap><sub>2</sub>, end-tidal partial pressure of CO<sub>2</sub> at anaerobic threshold (PET<smlcap>CO</smlcap><sub>2</sub>) and capillary to end-tidal carbon dioxide gradient [P(c-ET)<smlcap>CO</smlcap><sub>2</sub>] were significantly different between patients with CTEPH and controls (p < 0.001). P(c-ET)<smlcap>CO</smlcap><sub>2</sub> was the single parameter with the highest sensitivity (85.7%) and specificity (88.2%). A score combining V<smlcap>E</smlcap>/V<smlcap>CO</smlcap><sub>2</sub> slope, P(A-a)<smlcap>O</smlcap><sub>2</sub>, P(c-ET)<smlcap>CO</smlcap><sub>2</sub>, PET<smlcap>CO</smlcap><sub>2</sub> [4-parameter-CPET (4-P-CPET) score] reached a sensitivity of 83.3% and a specificity of 92.2% after cross-validation. In 42 patients with CTEPH, echocardiography identified PH in 29 patients (69%), but it was normal in 13 patients (31%). All patients with normal or unmeasurable right ventricular systolic pressure had a pathological CPET. Twelve of the 13 patients (92%) were detected by both CPET scores. <b><i>Conclusion:</i></b> CPET is a useful noninvasive diagnostic tool for the detection of CTEPH in patients with suspected PH but normal echocardiography. The 4-P-CPET score provides a high sensitivity with the highest specificity.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| 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) | 0.000 | 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 it