1998Long-term hemodynamic improvement after percutaneous mitral valve repair in the noninvasive pressure-volume analysis
Bibliographic record
Abstract
Background: The long-term hemodynamic adaptations of the cardiovascular system after percutaneous mitral valve repair (PMVR) are poorly understood. Purpose: We studied patients before and 12 months after PMVR using noninvasive pressure-volume analysis. Methods: 80 patients with severe (grade 3+ and 4+) and symptomatic (82.5% NYHA functional class III and IV) mitral regurgitation (MR) were treated with PMVR (Mitraclip). 45 patients (56%) were male, mean age was 74±11 years. 24 patients (30%) had primary and 56 patients (70%) secondary MR. Mean ejection fraction was 43±14%. Arm-cuff blood pressure was measured simultaneously with echocardiography at baseline and at 12 months to calculate pressure-volume parameters. Results: 12 months after PMVR, outcome data were available for 74 patients, 5 patients withdraw consent for participation and one patient was lost to follow-up. 14 patients (17.5%) had died, 12 of them had secondary MR. During the follow-up, 13 patients (16.3%) were hospitalized because of decompensated heart failure. 12 months after PMVR, MR grade was 0+ to 2+ in 90.5% of surviving patients and 75.5% were in NYHA functional class I and II. Left ventricular (LV) end-diastolic volume decreased from (mean±SD) 167±81ml to 147±79ml (p<0.0001), end-systolic volume changed from 103±70ml to 95±72ml (p=0.01). Thereby, total stroke volume (SV) was reduced from 64±23ml to 52±15ml (p<0.0001). Total ejection fraction and global longitudinal peak systolic strain remained similar to baseline, whereas forward ejection fraction increased (31±14% vs. 41±20%, p<0.0001). Since forward SV increased (43±12ml vs. 49±17ml, p=0.01) and HR remained unchanged cardiac index improved from 1.7±0.4l/min/m2 to 1.9±0.5ml/min/m2 (p=0.01) at 12 months. The peak power index reflecting LV contractility increased (220±116mmHg/s vs. 282±152mmHg/s, p=0.001). High baseline total peripheral resistance was reduced at 12 months (2423±666dynes×sec×cm5 vs. 2122±749dynes×sec×cm5, p=0.02). Stroke work of the LV was diminished (5941±2430mmHg×ml vs. 4515±1535mmHg×ml, p=0.0002) at 12 months while pressure-volume area representing total myocardial work was similar to baseline. Cardiac output relative to the pressure-volume area in one minute indicating efficacy of the operating heart improved (0.024±0.015 mmHg–1 vs. 0.031±0.019 mmHg–1, p=0.003). Glomerular filtration rate decreased from baseline to 12 months (41±17ml/1.73m2/min to 35±16ml/1.73m2/min, p<0.0001) without correlation to any hemodynamic parameter.
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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 | 0.001 |
| 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".