Surgical referral in symptomatic mitral regurgitation: greater compliance with guidelines is needed
Bibliographic record
Abstract
Significant valvular heart disease is a common public health problem with an overall prevalence of 2.5% which increases to 13% of the population aged 75 years and older.1 It will become an increasingly important problem as the baby-boomer population ages in the western world in the coming decades, because the burden of all forms of valve disease increases with age. Mitral regurgitation (MR) is the most common form of valve disease, and patients with severe MR can remain asymptomatic for many years.1 Once symptoms develop, these patients should undergo valve surgery.2 The study by Mirabel et al.3 provides important information as to why some symptomatic patients with severe MR are not referred for surgery. Their findings are based on the prospective Euro Heart Survey of patients with valvular heart disease conducted in 92 European centres in 2001. They examined the clinical characteristics and outcomes of patients with symptomatic severe MR (3+ and 4+) who were not referred for surgery and these patients accounted for about half of the 396 patients with severe symptomatic MR. Of those who underwent surgery, 41% had mitral valve repair. Many of the characteristics of patients not referred for surgery are expected and consistent with clinical practice. These patients were older and had lower ejection fraction (EF) and more co-morbidities. It is easy to understand the reluctance to perform mitral valve surgery in the elderly as they have limited life expectancy and higher operative mortality when compared with the younger age group. However, age by itself should not be a contraindication of surgery, because elderly patients derive similar benefits in terms of amelioration of symptoms and improved survival compared with younger patients.4 The increasing use of valve repair instead of replacement and refinement in surgical techniques have reduced the operative mortality across all age groups including the elderly.5,6
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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 | 0.004 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.006 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.031 | 0.020 |
| Insufficient payload (model declined to judge) | 0.022 | 0.008 |
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".