P2612Determinants of diagnostic delay in chronic thromboembolic pulmonary hypertension: results from the international prospective cteph registry
Bibliographic record
Abstract
Introduction: The median diagnostic delay (DD) of chronic thromboembolic pulmonary hypertension (CTEPH) has been reported to be as long as 14 months. The determinants and consequences of this delay have not been fully elucidated. Methods: The present analysis of the International CTEPH registry included 679 patients with CTEPH from Europe and Canada. First, we compared patient- vs physician-related DD. Subsequently, we performed univariate and multivariable regression analyses to study i) predictors of DD, and ii) the association between DD and clinical presentation or outcomes. We predefined to compare patients with the longest DD (highest tertile, >24.5 months) to those with shorter delay periods (lowest and middle tertile, ≤24.5 months). Results: In 637 patients, in whom the time of onset of CTEPH symptoms could be determined, stepwise multivariable analysis identified obesity (adjusted OR [aOR] per increase of DD by one tertile 1.5; 95% CI 1.01–2.2), chest pain (aOR 0.65; 95% CI 0.44–0.97) or fatigue (aOR 0.72; 95% CI 0.53–0.97) as the presenting symptom, and recurrent VTE (aOR 1.8; 95% CI 1.3–2.7), but not age or sex, as predictors of DD. Of note, formal adjudication of “recurrent VTE” was not required in the CTEPH registry, which may have led to recall bias and overestimation of its prevalence. Patients with the longest DD had higher mean pulmonary artery pressures at diagnosis (50±12 [III tertile] versus 45±12 [II tertile] versus 46±12 [I tertile] mmHg; p<0.001 for overall difference, p<0.001 for III versus II tertile, p=0.001 for III versus I tertile). DD was associated with overall mortality (adjusted hazard ratio 1.5; 95% CI 0.99–2.2) but not with patient operability.
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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 | 0.002 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.004 |
| 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".