Prognostic value of hemodynamics following treatment initiation in pulmonary arterial hypertension
Bibliographic record
Abstract
Background: The prognostic value of hemodynamic variables after treatment initiation in pulmonary arterial hypertension (PAH) is not well established. Methods: We evaluated incident patients between 2006-2016 with idiopathic, drug and toxin-induced or heritable PAH who had a follow-up right heart catheterization (RHC). The primary outcome was death or lung transplantation. We used stepwise Cox regression and receiver operating characteristic (ROC) analysis to assess variables at first follow-up RHC Results: Of 763 patients, death or transplantation occurred in 211 (27.7%) over a median follow-up time of 3.2 years (IQR25-75% 1.61-5.13). Median time to first follow-up RHC was 4.6 months (IQR 3.7-7.8). Multivariate predictors at first follow-up RHC were: age, male gender, idiopathic PAH, New York Heart Association functional class, 6-minute walk distance, stroke volume index (SVI), and right atrial pressure (RAP). Adjusted hazard ratios for hemodynamic variables were: SVI 0.975 (95%CI 0.961-0.989, p<0.01), and RAP 1.05 (95%CI 1.053-1.086, p<0.01). Optimal cut-points from ROC analysis were: SVI 38 mL/m2 (Area Under the Curve [AUC] 0.68) and RAP 9 mmHg (AUC 0.62). The addition of cardiac index, capacitance index (SVI/pulse pressure) or pulmonary vascular resistance index did not improve prediction. Among patients with cardiac index ≥2.5 L/min/m2 at first follow-up (n=531), those with SVI<38 mL/m2 had a worse prognosis (Log-rank test p<0.01). Conclusions: Stroke volume index and right atrial pressure at first follow-up catheterization were the best hemodynamic predictors of death or transplantation. These variables should be further validated as treatment targets in a prospective study.
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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 | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 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".