Incremental value of the echocardiogram to predict short- and long-term mortality and morbidity after surgical aortic valve replacement
Bibliographic record
Abstract
Purpose: Prediction of operative risk has become central to the therapeutic decision-making process for patients with severe aortic stenosis. Existing risk scores include very few echocardiographic parameters, and there has yet to be a study examining the incremental value of a complete echocardiogram. Methods: A cohort of patients with severe aortic stenosis undergoing surgical aortic valve replacement with or without coronary bypass was assembled at a General Hospital. Those with severe aortic regurgitation and those undergoing concomitant mitral or tricuspid valve surgery were excluded. Transthoracic echocardiograms performed within 3 months of operation were analyzed in order to measure echocardiographic parameters reflecting right and left sided chamber size and function as well as valvular function. The Society of Thoracic Surgeons (STS) database was queried to extract clinical parameters, and the national social security registry was queried to extract vital status. Results: The final cohort consisted of 321 patients with a mean age of 74±10 years and 36% females. The primary endpoint of STS-composite in-hospital mortality or major morbidity was observed in 26%. Multivariable logistic regression revealed that an average E/e' ratio >13 (OR 2.50; 95% CI 1.22, 5.14) and pulmonary artery systolic pressure >50 mmHg (OR 1.91; 95% CI 1.02, 3.57) were independent predictors. Addition of echocardiographic parameters to the STS risk score led to an increase in C-statistic from 0.73 to 0.77. The secondary endpoint of all-cause mortality over a mean follow-up of 2.3 years was observed in 11%, with moderate-to-severe tricuspid regurgitation (HR 3.32; 95% CI 1.39, 7.89) and left ventricular hypertrophy indexed (HR 2.70; 95% CI 1.22, 5.99) emerging as independent predictors in the Cox proportional hazards model. Conclusions: The echocardiogram adds incremental value above the STS risk score to predict short- and long-term outcomes after surgical aortic valve replacement. Specifically, pulmonary hypertension, tricuspid regurgitation, and two indices of diastolic dysfunction were found to be important predictors.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.028 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| 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".