Are indexed values better for defining exercise pulmonary hypertension?
Bibliographic record
Abstract
Pulmonary hypertension (PH) is defined by resting mean pulmonary arterial pressure (mPAP) ≥25 mmHg [1]. Patients with pulmonary vascular disease (PVD) or left heart disease (LHD) may demonstrate abnormal haemodynamic responses to exercise even when resting mPAP is normal [2]. After the 4th World Symposium on PH in 2008, exercise PH, defined as mPAP >30 mmHg during exercise, was abandoned due to a lack of supportive evidence and the observation that mPAP frequently exceeds 30 mmHg in healthy individuals who attain high cardiac output (CO) [3, 4]. A disproportionate increase in mPAP relative to CO during exercise, however, reflects either an increase in pulmonary vascular resistance (PVR), as in PVD, or elevated left ventricular filling pressure in LHD. Therefore, attention to the mPAP/CO relationship, such as the mPAP/CO slope or the total pulmonary resistance (TPRmax) >3 Wood units (WU) at maximal exercise, could refine the definition of an abnormal haemodynamic response to exercise in order to reduce false positive diagnoses [5–7]. Indeed, combining mPAP (mPAPmax) >30 mmHg and the TPRmax >3 WU at maximal exercise has been demonstrated to have high accuracy in discriminating patients with PVD or LHD and resting mPAP ≤20 mmHg from controls or healthy volunteers [7]. Furthermore, these criteria have superior diagnostic performance compared to either the mPAP/CO slope or change in mPAP/CO during exercise [8]. No advantage to using indexed total pulmonary resistance in the definition of exercise pulmonary hypertension We would like to acknowledge Marie Line Goubet and Antoine Goineau from the Cardiac Catheterization Laboratory, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, Hôpital de Bicêtre (Le Kremlin-Bicêtre, France) for their assistance in performing exercise haemodynamic testing.
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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 | 0.010 | 0.047 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.001 |
| Bibliometrics | 0.004 | 0.006 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.006 | 0.008 |
| Open science | 0.004 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.007 | 0.006 |
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".