Abstract 18664: Left Ventricular End-Diastolic Pressure is a Predictor of Survival in Patients Undergoing Coronary Artery Bypass Graft Surgery with Left Ventricular Dysfunction
Bibliographic record
Abstract
There is an association between depressed left ventricular ejection fraction (ejection fraction < 35%; LVEF) and increased mortality in patients undergoing coronary artery bypass graft (CABG). There are a few studies suggesting that elevated pre-operative left ventricular end-diastolic pressure (LVEDP) is an independent predictor of operative mortality for patients undergoing CABG, and could be a greater risk than LVEF < 35%. It is unclear if LVEDP is a better predictor of long-term survival than LVEF in patients undergoing CABG. We hypothesized that LVEDP may add further prognostic value than LVEF alone. We studied 6790 consecutive patients from 2004-2011 undergoing isolated CABG at our institution. Patients were divided into four groups based on LVEF and LVEDP: Group 1 (LVEF≥35%, LVEDP<18mmHg), Group 2 (LVEF<35%, LVEDP<18mmHg), Group 3 (LVEF≥35%, LVEDP≥18mmHg), and Group 4 (LVEF<35%, LVEDP≥18mmHg). The 4 groups had similar pre-operative characteristics of age, history of stoke, renal failure, peripheral vascular disease (PVD), hypertension, and hyperlipidemia. Patients with a low LVEF (Groups 2 and 4) had a higher incidence of chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), smoking and history of myocardial infarction (p<0.001). The Kaplan-Meier survival curves identified that the groups with preserved LVEF had improved long-term survival compared to groups with depressed LVEF (p<0.001). As well, there was no significant correlation between elevated LVEDP and decreased survival in patients with a preserved LVEF (Group 1 versus Group 3, p=0.84). However, in patients with depressed LVEF<35%, an elevated LVEDP was associated with worse long-term survival when compared to patients with an LVEDP<18mmHg (Group 2 versus Group 4, p<0.001). The independent predictors of death by Cox proportional hazards modeling were: LVEF<35%, advanced age, COPD, PVD, dialysis dependent renal failure, and CHF (p<0.001); while elevated LVEDP≥18mmHg was not significant. We conclude that elevated LVEDP≥18mmHg is not an independent risk factor for mortality in patients undergoing isolated CABG; however, in patients with depressed LVEF<35%, an elevated LVEDP further prognosticates a significant decrease in long-term survival.
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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 | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 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 | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 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 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".