Abstract 13855: Electrophysiological Substrate and Risk of Mortality in Incident Hemodialysis Patients: Predictors of Arrhythmic and Cardiovascular Risk in End-Stage Renal Disease (PACE) Study
Bibliographic record
Abstract
Introduction: Mortality in end-stage renal disease (ESRD) patients on dialysis is high; sudden cardiac death is the leading cause. Hypothesis: Left ventricular hypertrophy (LVH), late potentials on signal averaged ECG (SAECG) and wide spatial QRS-T angle are independently associated with mortality in incident hemodialysis patients. Methods: SAECGs were recorded at baseline (within 3-6 months of start of dialysis) in 360 participants [mean age 57.2±13.4 y; 59% male; 73% black; mean left ventricular (LV) ejection fraction (EF) 65.5±12.1%] from the Predictors of Arrhythmic and Cardiovascular Risk in End Stage Renal Disease study, a prospective cohort of incident hemodialysis participants. Spatial mean QRS-T angle was measured on an averaged beat. ECG-LVH was defined as sex-adjusted Cornell product >2440 mm*ms. Echo-LVH was defined as LV mass index >131 g/m2 (M); >113 g/m2 (F). Late potentials were detected on SAECG. All-cause mortality is the primary outcome. Results: During 2.4±1.3 years of follow-up, 75 patients died. Cumulative unadjusted mortality was higher in participants with QRS-T angle ≥ 75° (Figure). In Cox regression analyses, stratified by presence of bundle branch block, QRS-T angle ≥ 75° was associated with a greater than two-fold increase in risk for mortality after adjustment for age, sex, race, and BMI [HR 2.62(1.53-4.48); P<0.001]. The association remained significant after the addition to the model: 1) diabetes and prevalent cardiovascular disease [2.47(1.44-4.23); P=0.001], 2) LVEF, QRS duration, and LVH [2.64(1.53-4.55); P<0.0001], and 3) averaged 90-day serum albumin and creatinine [HR 2.29(1.28-4.10); P=0.005]. Abnormal SAECG, ECG-LVH and Echo-LVH were not associated with mortality. Conclusions: Spatial QRS-T angle, but not late potentials on SAECG or LVH, is independently associated with mortality after adjustment for both traditional and dialysis-related cardiovascular risk factors in incident hemodialysis.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".