Atrioventricular Block as the Initial Manifestation of Cardiac Sarcoidosis in Middle‐Aged Adults
Bibliographic record
Abstract
INTRODUCTION: Atrioventricular block (AVB) can be caused by several conditions, including cardiac sarcoidosis (CS). The prevalence of CS causing this presentation in a North American population has not been investigated and was the purpose of this study. METHODS: We prospectively evaluated patients aged 18-60 years presenting with unexplained 2nd or 3rd degree AVB and no previous history of sarcoidosis in any organ. All patients had fluorodeoxyglucose-positron emission tomography (FDG-PET) scans for the evaluation of CS. Japanese Ministry of Health Welfare (JMHW) criteria and biopsy results were used to confirm the diagnosis of CS. Subjects with advanced imaging suggestive of CS were investigated for extracardiac involvement. Patients were followed for major adverse cardiac events. RESULTS: Thirty-two patients presenting with unexplained AVB underwent cardiac and whole body FDG-PET for the investigation of CS from February 2010 to June 2013. Mean age was 52.8 ± 6.2 years, and 20 were male. CS was diagnosed in 11/32 (34%) subjects and 11/11 were subsequently diagnosed with extra-CS. Average follow-up was 21 ± 9 months. Adverse events were observed in 3 subjects with CS but none in subjects with idiopathic AVB. All 3 patients presented with heart failure, 2 also had recurrent VT resulting in ICD shocks. CONCLUSIONS: In this prospective study of consecutive patients aged ≤60 years presenting with unexplained AVB, we found that 11/32 (34%) had previously undiagnosed CS. Among patients with CS, 3/11 had adverse clinical outcomes compared with 0/21 (P = 0.011). Our data suggest that all patients aged ≤60 years with unexplained AVB should be investigated for CS. Moreover, patients diagnosed with CS should be closely followed.
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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 | 0.001 |
| 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 | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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".