A shifting heart shifts the transition index
Bibliographic record
Abstract
Numerous algorithms have been developed to assist localisation of outflow tract ventricular tachycardia (VT); however, they are all influenced by subtle differences in precordial and limb lead electrode placement. Another consideration is the cardiac location, even within the same patient as presented here. A syncopal young lady with ventricular outflow tract VT was 7 months pregnant at first presentation. Standard electrocardiogram (ECG) recording showed left bundle branch block (LBBB)-like pattern, cardiac axis +80°, precordial transition in lead V2 and transition zone index (TZI) = −1.0 compared with sinus. Echocardiography was normal. Two years later, she represented, and her ECG (Panel A) showed outflow tract ectopy. While still LBBB-like pattern the ectopy now had cardiac axis +100°, precordial transition between leads V3/V4 (dotted blue box) and TZI = −0.5. Alternate precordial lead positions, 1 intercostal space above (high) and below (low) (Panel A) revealed that ‘low’ leads were identical to the previous ‘pregnant’ ECG as could be predicted by diaphragmatic splinting by the gravid uterus. The EnSite Map (st Jude's Medical) created during definitive VT ablation confirms the location of the ectopic focus as an anterior aspect of the left ventricular outflow tract (Panel B). This case highlights how a shift in the intrathoracic cardiac position can alter the cardiac axis, precordial transition and the transition index. Similar changes may occur in ascitic (superior cardiac movement) and emphysematous (inferior cardiac movement) patients. Conflict of interest: none declared. The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/Documents/shifting-heart-shifts.pdf
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How this classification was reachedexpand
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) | 0.000 | 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) | 0.000 | 0.001 |
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 teacher head, 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".