Concomitant mitral regurgitation: an insidious cause of lowflow, low-gradient severe aortic stenosis
Bibliographic record
Abstract
The combination of aortic stenosis (AS) and mitral regurgitation (MR) is frequent in patients with valvular heart disease. This entity raises important challenges with regard to severity grading and therapeutic management of both AS and MR. Long-standing afterload excess associated with severe AS induces hypertrophic remodelling, dilatation and/or dysfunction of the left ventricle (LV). Secondary MR may develop in this context as a result of mitral valve leaflet tethering and mitral annular dilatation. Because of the high prevalence of concomitant coronary artery disease, ischaemic MR is also frequent in the elderly population with AS. Elderly patients may also present primary MR as a result of degenerative and calcified mitral valves. In the Euro Heart Survey, multiple valve disease, as defined by at least two moderate valvular diseases, was observed in 20% of the patients with native valve disease and in 17% of those undergoing intervention. In a Swedish nationwide study, multiple and mixed valve diseases accounted for 11% of patients and the most frequent combinations were i) AS and MR, and ii) aortic regurgitation and MR. Despite the relatively high prevalence of the concomitance of AS and MR, there are limited data on the pathophysiology, diagnosis, and management of this multiple valve disease entity.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.006 | 0.004 |
| Insufficient payload (model declined to judge) | 0.002 | 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".