Assessment of aortic stenosis severity: when the gradient does not fit with the valve area: Figure 1
Bibliographic record
Abstract
In this issue of Heart , Minners et al 1 ( see page 1463 ) provide an extension of their previous work2 where they retrospectively analysed the data of their Doppler-echocardiography laboratory and reported that there is a discrepancy in the criteria of aortic valve area (AVA; 40 mm Hg) proposed in the guidelines to define severe aortic stenosis (AS).2 In the present study1 they present data obtained by cardiac catheterisation in a subset of the previous series.2 The main findings of this study are: (1) when using the framework of the current guidelines, inconsistent grading of AS (ie, AVA <1.0 cm2 but gradient ≤40 mm Hg) occurred in 36% of patients with preserved left ventricular (LV) systolic function (LV ejection fraction (LVEF) ≥50%), and this proportion was similar irrespective of the method used to assess stenosis severity (ie, Doppler-echocardiography vs cardiac catheterisation); and (2) the proportion of patients with reduced stroke volume (stroke volume index ≤35 ml/m2) despite apparently normal LV systolic function was substantially higher in the subset of patients with inconsistent grading (52%) than in those with consistent grading (29%). This latter finding lends further support to the concept that discordance between AVA and gradient is often due to paradoxical low-flow AS, a disease pattern recently described by our group.3 We indeed reported that an important proportion of patients with severe AS may paradoxically have a low flow and thus often a low gradient, despite the presence of normal LVEF.3 When compared with patients with normal LV outflow, patients with paradoxical low flow are characterised by a higher prevalence of women and concomitant hypertension, older age, a higher degree of LV concentric remodelling, impaired LV filling, smaller end-diastolic volume and reduced mid-wall and longitudinal shortening. These patients also have markedly increased global …
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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) | 0.001 | 0.001 |
| 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 | 0.002 |
| Insufficient payload (model declined to judge) | 0.000 | 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 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".