Abstract 16108: Right Ventricular Strain is a More Sensitive Marker of Right Ventricular Dysfunction Than Right Ventricular Ejection Fraction in a Cohort of Patients With Idiopathic Pulmonary Arterial Hypertension
Bibliographic record
Abstract
Introduction: Strain has been shown to be more sensitive that ejection fraction in detecting subclinical dysfunction in the left ventricle. A number of echocardiographic parameters associated with right heart size and function have been shown to be impaired in idiopathic pulmonary arterial hypertension (IPAH) but there is minimal data on which may be the most sensitive. Aim: To characterize the changes in functional and echocardiographic indices of right ventricular (RV) size and function, in a cohort of IPAH patients followed serially to determine if strain is a more sensitive measure of RV dysfunction than RVEF. Methods: Thirty patients (24 women, mean age 46.8 ± 5.3 years) with newly diagnosed IPAH were prospectively recruited and followed with serial transthoracic echocardiograms (TTE; Philips Medical Systems, Andover, MA) 6 monthly for up to 18 months. A range of 2D and 3D echocardiographic measures of right ventricular dimensions and function, including right ventricular ejection fraction (RVEF) and systolic longitudinal strain (LS), was assessed at each time point after commencing treatment using vendor independent software (TomTec, Germany). Functional status was assessed at18 months. Statistical analyses were performed using JMP statistical package (SAS Institute In. Cary, NC) Results: 3D RV volumes, ejection fraction, mass, 2D global strain and 2D free wall strain all show significant changes over 18 months (p-value < 0.05; ANOVA of repeated measures) although peak tricuspid regurgitant velocity, RV systolic pressure and stroke volume do not. However, RV global strain and RV free wall strain showed significant changes within 6 months after diagnosis but not RVEF, peak TR velocity or RVSP. The degree of change in the RV free wall strain change at 18 months but not RVSP, RV mass or RVEF, was also associated with an abnormal 6 min walk test (18 months change, p=0.03). Conclusion: RV global and free wall strain demonstrate significant decreases prior to RVEF, peak TR velocity and RVSP hence may be more more sensitive measures of RV dysfunction in patients with IPAH. These results may help guide treatment decisions and highlight the potential value of echocardiography in detecting subacute cardiac pathology.
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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 | 0.000 | 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 | 0.000 |
| Insufficient payload (model declined to judge) | 0.004 | 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".