Value of magnetic resonance and exercise echocardiography to predict outcome in patients with hypertrophic cardiomyopathy
Bibliographic record
Abstract
Wall Motion Abnormalities (WMAs) during Exercise Echocardiography (EE) are associated to events in Hypertrophic Cardiomyopathy (HCM). We aimed to evaluate Magnetic Resonance (MR) and EE to predict outcome in HCM. Methods: EE and MR (perfusion and delayed hyperenhancement [DHYPER]) were performed in 148 pts with HCM (age 51±15 years), normal LV function (LVEF≥50) and absence of history of coronary disease. Results: During follow-up (5.9±2.7 years), there were 6 hard events (4 cardiac failure, 1 stroke, 1 appropriate discharge of defibrillator) and 25 combined events (including new atrial fibrillation and syncope). WMAs at EE were seen in 13 pts (8.7%), perfusion defects (PDef) in 11 (7.4%) and DHYPER in 47 pts (31.8%). WMAs were seen in 50% of pts with hard events vs. 7% of those without hard events (p=0.009), and in 20% and 7% of pts with and without combined events (p=0.046). A PDef and/or DHYPER in ≥3 segments (sg) was seen in 50% and 15% of pts with and without hard events (p=0.05), and in 36% and 12% of pts with and without combined events (p=0.003). Univariate predictors of hard events were peak double product (DP) (p=0.03), peak wall motion score index (PWMSI) (p=0.02), and no. of sg with PDef (p=0.001). Univariate predictors of combined events were a NYHA functional class ≥2 (p=0.02), left atrial size (p=0.03), DP (p=0.03), resting WMSI (p=0.03), PWMSI (p<0.001), and MR data (no. sg with PDef, p=0.003; no. sg with DHYPER, p=0.004; PDef and/or DHYPER in ≥3 sg, p=0.002). DP (HR=0.99, CI 95% 0.99-0.99, p=0.008) and no. sg with DHYPER (HR=1.26, CI 95% 1.08-1.48, p=0.004) remained independent predictors. PWMSI correlated with the no. of sg with PDef (r=0.45; p<0.001) and with the no. sg with DHYPER (r=0.20; p=0.015). A PDef and/or DHYPER in ≥3 sg was seen in 46% of pts with WMAs during ExE and in 13% of those without (p=0.002). Independent associations of a perfusion defect and/or DHYPER in ≥3 sg. were age (OR 0.96, 95% CI 0.94-1.00, p=0.026), a positive/nonconclusive ECG exercise testing (OR 6.42, 95% CI 1.82-22.7, p=0.004) and presence on WMAs during exercise (OR 11.41, 95% CI 2.66-49.01, p=0.001). Of the 4 groups formed according to the presence/absence of a perfusion defect and/or DHYPER in ≥3 sg and WMAs at ExE, the group with negative results by both techniques had better outcome (log rank test 12, p=0.008) In conclusion, PDef and/or DHYPER by MR are associated to WMAs during EE in pts with HCM. MR may help to predict outcome in them.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".