Abstract 13983: Tricuspid Regurgitation is Independently Associated With Increased Risk of Mortality in Patients with Low-Flow Low-Gradient Aortic Stenosis and Reduced Ejection Fraction-Results From the TOPAS Study
Bibliographic record
Abstract
Background: Tricuspid regurgitation (TR) is often observed in patients (pts.) with low-flow, low-gradient aortic stenosis (LF-LG AS) and low ejection fraction (EF). Its impact on prognosis remains unknown. The objective of this study was to examine the impact of TR on mortality in these pts. Methods: 211 pts. (age=73±10 yrs; 77% men) with LF-LG AS (mean gradient<40 mmHg, AVA ≤0.6 cm2/m2) and low EF (≤40%) were prospectively enrolled and 125 (59%) underwent aortic valve replacement (AVR) within 3 months following inclusion. AS severity was assessed by the projected AVA. The severity of TR was graded according to ASE guidelines. Right ventricular (RV) function was assessed using an integrative approach and classified as normal or reduced. Results: Among the 211 pts., 76 (36%) had TR (24% mild TR and 12% moderate/severe TR). During a mean follow up of 2.4±2.2 yrs, 104 (49%) died. In univariable analysis, TR was associated with an increased risk of all-cause mortality (overall TR: HR=1.82; 95% CI=1.22-2.71; p=0.004; mild TR: HR=1.62; 95% CI=1.02-2.54; p=0.04; moderate/severe TR: HR=2.30; 95% CI=1.27-3.93; p=0.007). After adjustment for risk factors and echocardiographic parameters including RV function, TR was an independent predictor of mortality (overall TR: HR=1.88; 95% CI=1.08-3.23; p=0.02; mild TR: HR=2.19; 95% CI=1.00-4.77; p=0.05; moderate/severe TR: HR=2.68; 95% CI=1.08-6.32; p=0.03). Furthermore, moderate/severe TR was an independent predictor of 30-day mortality following AVR compared to none/trace TR (OR=7.24; p=0.01) and mild TR (OR=4.70; p=0.05). Conclusion: In patients with LF-LG AS and low EF, TR is independently associated with an increased risk of mortality. Moderate/severe TR is associated with increased 30-day mortality following AVR. Further studies are needed to determine whether TR is a risk marker or risk factor of mortality, and whether concomitant surgical correction at the time of AVR can improve outcome in these high risk patients.
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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) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| 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) | 0.002 | 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".