965Increased heart rate is independently associated with worse survival in pediatric patients with dilated cardiomyopathy: a multicenter study from the pediatric cardiomyopathy registry
Bibliographic record
Abstract
Background: Among adult heart failure (HF) patients, elevated heart rates are associated with an increased risk of adverse outcomes including overall mortality, cardiovascular death, and HF hospitalizations. There are few data on the association of heart rate and outcomes in HF pediatric patients. Purpose: We aimed to test the hypothesis that increased heart rate is associated with an increased risk of death and transplant in pediatric dilated cardiomyopathy (DCM) patients. Methods: The Pediatric Cardiomyopathy Registry, a large prospective registry of pediatric cardiomyopathy patients in North America, was analyzed for patients enrolled with the diagnosis of DCM from 1994–2011. Patients with a diagnosis of myocarditis, neuromuscular disease, mixed cardiomyopathy, and malformation syndromes were excluded. Heart rates were recorded at the time of study entry. Increased heart rate was defined as being ≥2 standard deviations of the mean normal value based on age. Results: 557 patients, 282 (51%) male, met enrollment criteria. Median age was 1.3 [interquartile range (IQR) 0.3, 9.8] years and median follow-up time of 1.8 years (IQR, 0.3 to 5.1 years). Increased heart rate was present in 192 (34%). Patients with an increased heart rate were older (median age 2.3 years, IQR 0.6,11.6 vs 0.9 years, IQR 0.2, 8.4; p<0.001), having HF symptoms (83% vs 67%; p<0.001), having worse ventricular function (median fractional shortening z-score -9.7, IQR -11.5, -7.5 vs -9.1, IQR -11.3, -6.2; p=0.02), and more likely to be receiving anticongestive therapies (96% vs 86%; p<0.001) and antiarrhythmic medications (31% vs 21%; p=0.008) compared to patients with normal heart rate. Beta-adrenergic blockers usage was similar in both groups (17% vs 14%; p=0.4). Survival analysis demonstrated that patients with an increased heart rate at study entry had higher mortality and lower transplant-free survival compared to patients with normal heart rate (p<0.01 for both) (Figure). On multivariable analysis controlling for age, ventricular function, and cardiac medications, the presence of an increased heart rate was independently associated with death (adjusted hazard ratio HR=2.6; IQR 1.55, 4.36; p<0.001) and death or transplant (adjusted HR 1.5; IQR 1.1, 2.1; p=0.01). Competing risk analyses showed results that are comparable to the Cox regressions.
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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| 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".